Employment Type:Full time
Shift:Day Shift
Description:Position SummaryThe
Nurse Manager - 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 high-quality, cost-effective, patient-centered care while optimizing throughput, length of stay, and regulatory compliance.
Key Responsibilities- Lead Care Coordination, Case Management, and Utilization Management teams, including staff development, performance management, and engagement
- Promote evidence-based nursing practice, patient safety, and interdisciplinary collaboration
- Oversee utilization management processes, level-of-care 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 system-wide committees and strategic initiatives
Required Qualifications- Active Registered Nurse (RN) license in Pennsylvania
- BSN required; MSN or Master's 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 change-leadership skills
Preferred Qualifications- Master's degree (MSN or related healthcare field)
- Experience in utilization management, denial management, and payer relations
- Prior leadership experience in a large health system or multi-department environment
- Knowledge of CMS regulations, payer requirements, and care management best practices
