Manager Clinical Resource / Case Management

Position Overview 

The Manager of the Clinical Resource Department is responsible for the day-to-day operations and clinical management of Case Management, Utilization Review, and Social Work, with secondary oversight of Clinical Documentation. The role focuses on discharge planning, utilization management, care coordination, and high-risk patient processes while maintaining efficient department operations. 

Key Responsibilities 

• Manage day-to-day operations of case management and social services teams including scheduling and performance evaluations 
• Conduct rounds on patient units to identify discharge barriers and facilitate care coordination 
• Develop and deliver continuing education programs for Case Management and Social Work staff 
• Provide onboarding and ongoing training for staff, physicians, and allied health professionals 
• Track and analyze compliance data and build dashboards for performance improvement 
• Mentor and coach teams to enhance collaboration with physicians and nursing staff 
• Analyze program metrics and identify opportunities for process improvement 
• Stay current with CMS and regulatory requirements 
• Drive continuous improvement initiatives and present recommendations to leadership 

Required Qualifications 

• Bachelor’s degree in Nursing (required) 
• Active Massachusetts Registered Nurse (RN) License 
• Minimum 5 years of Case Management experience in an acute care setting 
• At least 2 years of process improvement experience 
• Experience developing and presenting professional education programs 
• Knowledge of CMS regulations 
• Epic EMR experience 
• Strong organizational, analytical, and communication skills 

Preferred Qualifications 

• Master’s degree in Nursing or related field 
• Certification in Case Management or Clinical Documentation Integrity 
• Management or supervisory experience 
• Working knowledge of InterQual or equivalent system