When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
The Nurse Manager, Case Management provides operational and clinical leadership for care transition processes across the continuum of care. This role is accountable for the oversight, coordination, and evaluation of discharge planning,utilizationmanagement, andpost‑acutetransitions to ensure safe,timely, andhigh‑qualitypatient outcomes.
The Managermaintains24‑hour accountability for the daily operations of the care transitions team, promotes interdisciplinary collaboration, supports regulatory compliance, and leads initiatives focused on patient throughput, denial avoidance, readmission reduction, and patient experience. The Manager serves as a key liaison between medical staff, nursing leadership,post‑acuteproviders, payers, and hospital administration.
Essential Responsibilities
Operational & Clinical Leadership
Providesday‑to‑daymanagement and oversight of care transition and case management functions across inpatient and emergency department settings.
Ensures consistent,high‑qualitydischarge planning and care transition practices aligned with regulatory, payer, and organizational standards.
Overseesutilizationreview, denial management, and medical necessity processes tooptimizereimbursement andappropriate levelof care.
Monitors patient flow, length of stay, and discharge efficiency;identifybarriers andimplementscorrective actions.
Maintains established policies, procedures, and performance standards for care transitions and case management services.
Staff Leadership & Development
Supervises, coaches, and supports nurse case managers and care transition staff.
Provides guidance on complex orhigh‑riskcases, escalations, and ethical/regulatory concerns.
Participates in staff onboarding, education, competency validation, and ongoing performance management.
Fostersa collaborativeandaccountable, andpatient‑centeredteam culture.
Interdisciplinary Collaboration
Builds and sustains collaborative relationships with physicians, nursing leadership, social work,utilizationmanagement, and ancillary departments.
Serves as a clinical and operational resource for providers and leadershipregardingcare transitions and discharge planning.
Partners withpost‑acutefacilities, home care agencies, and community providers to ensure smooth and safe transitions of care.
Quality, Compliance & Performance Improvement
Ensures compliance with CMS, Conditions of Participation, accreditation standards, and payer requirements.
Participates in quality improvement initiatives related to readmissions, patient experience, andcarecoordination outcomes.
Usesdata and metrics (LOS, denials, readmissions, throughput) to guide performance improvement strategies.
Supports audits, regulatory reviews, and process improvement initiatives related to care transitions.
Administrative Responsibilities
Assistsin staffing oversight, scheduling support, and workload management.
Contributes to policy development, program planning, and departmental goals.
Provides reports and updates to senior leadership related to performance metrics and operational needs.
Required Education & Experience
Registered Nurse (RN) with current Massachusetts licensure.
Bachelor of Science in Nursing (BSN) preferred.
Five (5) or more years ofhospital basedcase management or care coordination experience.
Five (5) or more years of acute care medical/surgical experience.
Demonstrated knowledge ofutilizationreview, denial management, and discharge planning workflows.
Prior leadership or management experience strongly preferred.
Preferred Certifications
Certified Case Manager (CCM) or equivalent certification preferred.
Key Competencies
Strong leadership, communication, and organizational skills
Ability to manage complex clinical and operational issues.
High levelof collaboration and professionalism.
Knowledge of payer requirements, compliance standards, and care transition best practices.
Commitment topatient centeredcare and quality outcomes.
Pay Range:
$125,000.00 USD - $188,000.00 USD
The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.
Beth Israel Lahey Health is a new, integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what health care can and should be.
