Job Description
The Lead, RN Case Manager is an experienced RN Case Manager who provides clinical and operational support to the Care Management leadership team. In addition to performing the full scope of an RN Case Manager, the Lead is responsible for supporting department operations, conducting audits, reinforcing regulatory compliance, leading assigned performance improvement projects, and ensuring standardization and quality in utilization review, care coordination, and discharge planning. Provides real-time guidance to team members, supports onboarding and competency development, leads quality and documentation audits, participates in throughput initiatives, and assists in implementing workflows and education to support safe and timely transitions of care. Manages the Student Internship and Preceptor Program for RN case management students, serving as liaison to academic partners and coordinating onboarding, preceptor assignments, and ongoing education.
Required Skills
• Demonstrated ability to provide consultation and instruction to staff regarding their assessment, intervention, planning and evaluation of cases.
• Contributes to staff performance annual evaluation, performs staff annual competencies evaluations, provides staff orientation and training.
• Strong working knowledge of CMS Conditions of Participation for Discharge Planning and Utilization Review, InterQual/MCG criteria, payer requirements, and hospital policies.
• Knowledge with regulatory agency requirements, policies, and protocols.
• Demonstrate leadership and organizational skills.
• Independent performer and manages multiple assignments in a fast-paced environment.
• Strong critical thinking and problem-solving skills to identify and resolve problems and or escalate barriers to support throughput.
• Excellent communication and writing skills
Required Experience
• Current California license as current California RN license
• Bachelor's degree of Science in Nursing
• 3 or more years of work experience as a case manager in hospital inpatient healthcare setting
• Evidence of continuing education and obtain ACM (Accredited Case Manager) within 3 years of hire.
