Position Purpose

At Mercy Medical Center the Case Management Department helps patients coordinate and navigate through their Health care needs while determining how to provide that care efficiently to control costs.

The Nurse Manager 6 Case management provides strategic and operational leadership for inpatient care coordination, case management, and utilization management services. This role partners with physicians, hospital leadership, and system stakeholders to ensure highquality, costeffective, patientcentered care while optimizing throughput, length of stay, and regulatory compliance.

Key Responsibilities

• Lead Care Coordination and Case Management teams, including staff development, performance management, and engagement

• Promote evidencebased nursing practice, patient safety, and interdisciplinary collaboration

• Oversee utilization management processes, levelofcare determinations, concurrent reviews, denials management, and appeals

• Collaborate with Physician Advisors, Finance, Revenue Integrity, Patient Access, and Compliance teams

• Monitor CMS and payer compliance (IMM/MOON, authorizations, documentation standards)

• Drive patient flow initiatives to support timely admissions, transitions of care, and discharge planning

• Analyze data, trends, and outcomes to support quality improvement and financial stewardship

• Participate in hospital and systemwide committees and strategic initiatives

• Support effective use of EPIC (TogetherCare) and reporting tools

Required Qualifications

• Active Registered Nurse (RN) license inMassachusetts

• BSN required; MSN or Masters in related field preferred

• Minimum 5 years of healthcare experience, including leadership or management

• Experience in care coordination, case management, utilization management, or patient flow

• Strong communication, analytical, and changeleadership skills

Preferred Qualifications

• Masters degree (MSN or related healthcare field)

• Experience in utilization management, denial management, and payer relations

• Prior leadership experience in a large health system or multidepartment environment

• Knowledge of CMS regulations, payer requirements, and care management best practices

• Work hours/Shift: 40 hours Full time Days

Mercy Medical Center has established itself as one of the leading providers of health care services in Western Massachusetts. Mercy Medical Center is a 182-bed acute care hospital in Springfield. Other facilities include Mercy's Rehabilitation Hospital, a comprehensive hospital-based rehabilitation center on the campus of Mercy Medical Center and Brightside for Families and Children, an outpatient service offering counseling and family support programs.