Nurse Manager - Case Management

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, utilization management, and post‑acute transitions to ensure safe, timely, and high‑quality patient outcomes. 

The Manager maintains 24‑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‑acute providers, payers, and hospital administration.  

Essential Responsibilities 

Operational & Clinical Leadership 

• Provides day‑to‑day management and oversight of care transition and case management functions across inpatient and emergency department settings. 

• Ensures consistent, high‑quality discharge planning and care transition practices aligned with regulatory, payer, and organizational standards. 

• Oversees utilization review, denial management, and medical necessity processes to optimize reimbursement and appropriate level of care. 

• Monitors patient flow, length of stay, and discharge efficiency; identify barriers and implements corrective 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 or high‑risk cases, escalations, and ethical/regulatory concerns. 

• Participates in staff onboarding, education, competency validation, and ongoing performance management. 

• Fosters a collaborative and accountable, and patient‑centered team culture. 

Interdisciplinary Collaboration 

• Builds and sustains collaborative relationships with physicians, nursing leadership, social work, utilization management, and ancillary departments. 

• Serves as a clinical and operational resource for providers and leadership regarding care transitions and discharge planning. 

• Partners with post‑acute facilities, 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, and care coordination outcomes. 

• Uses data 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 

• Assists in 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 of hospital based case management or care coordination experience. 

• Five (5) or more years of acute care medical/surgical experience. 

• Demonstrated knowledge of utilization review, 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 level of collaboration and professionalism. 

• Knowledge of payer requirements, compliance standards, and care transition best practices. 

• Commitment to patient centered care and quality outcomes.