Manager - Case Management - RN - Coordinated Care

Job Summary

Functions as the direct supervisor for daily tasks of an assigned team of Case Managers. Serves as an experienced clinical professional, coordinating management activities including employee selection, performance evaluations, scheduling, team outcomes management, and data collection and reporting. Oversees utilization reviews, case coordination, discharge planning, and patient placement. Identifies and removes barriers to promote effective resource utilization and efficient team productivity.

Education & Experience

• Four (4) years of nursing experience in case management, utilization review, utilization management, or discharge planning including one (1) year of nursing leadership experience.
• Required: Valid RN license. Certified Case Manager from the Certified Case Management Commission and Accredited Case Manager from the American Case Management Association.

Knowledge, Skills & Abilities

• Knowledge of utilization review, discharge planning, case management, and managed care reimbursement.
• Strong working knowledge of medical procedures, diagnoses, and coding systems, including ICD-10, CPT, and DSM-IV.
• Effective interpersonal, verbal, and written communication skills, including negotiation and collaboration.
• Ability to analyze data, prepare reports, and identify process improvements.
• Demonstrates sound judgment and ensures consistent application of medical necessity guidelines across the team.
• Committed to quality patient care, customer service, safety, cost efficiency, and continuous quality improvement (CQI).
• Proficient in the use of computers and related software applications.

Responsibilities

• Determines staffing needs, establishes required qualifications and skill sets, and participates in hiring activities in collaboration with administration and other stakeholders.
• Serves as a resource for resolving complex patient placement issues.
• Supports ongoing staff development activities in collaboration with the department director.
• Provides backup coverage for case managers as needed to ensure departmental goals and operational continuity are maintained.

Physical and Environmental Demands

• Requires occasional exposure to bio-hazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations.
• Occasional working hours significantly beyond regularly scheduled hours.
• Occasional activities subject to significant volume changes of a seasonal/clinical nature.
• Occasional bending, occasional lifting and carrying up to 10 pounds, occasional crouching/stooping, occasional kneeling, occasional pushing/pulling, occasional reaching, frequent sitting, frequent standing, occasional twisting, and constant walking.