Manager Inpatient Care Management

Overview

CentraState Healthcare System, headquartered in Freehold, New Jersey, is a leading nonprofit healthcare provider dedicated to serving the community. Its comprehensive network includes CentraState Medical Center, a community-focused hospital, an ambulatory campus, two senior living facilities, three free-standing community health pavilions, and a charitable foundation. As the third-largest employer in Monmouth County, CentraState has earned repeated recognition as a Great Place to Work-Certified™ company, reinforcing its reputation as an exceptional workplace.

Responsibilities

• Oversees daily operations of Care Management and Social Work, including utilization review, care coordination, and discharge planning.
• Supervises and supports case managers and social workers, including staffing, work assignments, and performance management.
• Ensures timely and appropriate utilization review processes, including medical necessity determinations, payer communication, and escalation to Physician Advisors.
• Maintains compliance with CMS regulations and utilization management requirements, including Condition Code 44, MOON, IMM, and HINN notices.
• Monitors documentation standards and completion of utilization reviews, payer communications, and physician advisor referrals in accordance with policy.
• Promotes interdisciplinary collaboration to facilitate progression of care and timely discharge planning.
• Maintains productivity standards and ensures appropriate workload distribution across the team.
• Participates in hospital, medical staff, and system committees, including the Utilization Review Committee.
• Maintains collaborative relationships with internal departments and external providers across the continuum of care.

Qualifications

• Bachelor's degree in Nursing or Social Work required.
• Master's degree in Nursing or Social Work preferred.
• Minimum of 3–5 years of acute care case management or utilization review experience required.
• Experience with utilization management regulations and discharge planning required.
• Prior leadership experience preferred.
• Valid NJ RN License required, or Valid Licensed Social Worker required.
• Case Management Certification (CCM, ACM), preferred.
• Knowledge of relevant and state utilization review and appeals requirements.
• Strong professional, organizational, and interpersonal skills to effectively relate with all members of the healthcare team.
• Rapid cycle change or clinical performance improvement expertise.
• Data and computer skills.
• Excellent communication, negotiation, and conflict resolution skills.