Case Management Nurse

💰
Salary: $80,000 – $95,000 annually

We are seeking an experienced RN Case Manager to support inpatient utilization management, care coordination, and safe discharge planning. This role works closely with physicians, interdisciplinary teams, and payers to ensure appropriate level of care, regulatory compliance, and optimal patient outcomes.

• Perform inpatient utilization management and medical necessity reviews
• Collaborate with physicians and care teams on patient management and discharge planning
• Collect and submit clinical data to support DRG accuracy and payer requirements
• Identify and resolve barriers to care progression and discharge delays
• Coordinate referrals to social services and community resources
• Communicate potential denials or level-of-care concerns to physician advisors
• Serve as a central liaison between internal teams and external stakeholders
• Promote cost-effective care without compromising quality or patient safety

• Graduate of an accredited nursing program
• 2+ years of relevant clinical experience preferred
• Utilization management experience strongly preferred
• Knowledge of Medicare, Medicaid, Managed Care, and Commercial insurance processes
• Strong communication, organization, and customer service skills
• Proficiency in Microsoft Word and Excel