Registered Nurse Manager Case Management

Registered Nurse Manager Case Management Overview

• The Registered Nurse Manager Case Management oversees case management, social work, utilization management, and discharge planning within a healthcare organization.
• Leads clinical care teams to address patients' psychosocial and financial needs, ensuring quality outcomes.
• Provides 24/7 leadership and management, ensuring compliance with regulations and professional standards.
• Collaborates with internal and external stakeholders, including patients, families, physicians, and third-party payors.
• Promotes teamwork and continuous quality improvement processes to enhance program effectiveness.
• Supports innovative programs in heart and vascular care, stroke treatment, cancer care, and women's health services.
• Ensures effective utilization management and discharge planning practices within the organization.
• Contributes to the organization's emergency and trauma care, cardiac rehabilitation, and wellness programs.

Registered Nurse Manager Case Management Key Responsibilities & Duties

• Supervise and evaluate case management and social work team members, ensuring high productivity and quality of service.
• Monitor workflow processes and regulatory compliance to maintain operational efficiency.
• Develop and implement program goals, plans, and continuous improvement initiatives.
• Collaborate with healthcare professionals to address complex medical, emotional, and social needs of patients.
• Utilize Meditech and Inter-Qual Criteria for effective case management practices.
• Provide leadership in acute case management and innovative program development.
• Ensure compliance with CMS, Title 22, CHA Consent Manual, and TJC standards.
• Represent the organization to patients, families, physicians, and external stakeholders.

Registered Nurse Manager Case Management Job Requirements

• Bachelor’s degree in Nursing required; Master’s degree preferred.
• Current California RN License and BLS Provider Care certification mandatory.
• National certification from ANCC, ACMA, or Case Management Association of America preferred.
• Minimum of 3 years of experience in case management; 5 years preferred.
• Leadership experience in acute case management and utilization management required.
• Proficiency in Meditech, Inter-Qual Criteria, and managed care software programs.
• Strong problem resolution, customer relations, and interpersonal skills.
• Comprehensive knowledge of laws and regulations affecting case management practices.