Manager, Case Management

Job Summary

The role encompasses assisting the department director with supervision, development, clinical performance, and management of the Case Management department and staff. The incumbent will provide oversight of utilization review and discharge planning to promote compliance with hospital policy, mission, values, accreditation/regulatory requirements, and payer requests for information. This includes improving the overall quality and completeness of physician clinical documentation of diagnosis and procedure using terminology integral to HIPAA‑related transaction sets, primarily in inpatient and observation admissions.

• Education — Bachelor’s degree in nursing or other health‑related field, or currently enrolled in a Bachelor’s degree program.
• Experience — Minimum of 5 years’ experience in acute hospital nursing. Previous management experience and a minimum of 3 to 5 years’ experience in utilization review using Inter Qual Criteria, and/or Milliman Care Guidelines, discharge planning, and case management is required.
• Knowledge and Skills — Knowledge of pathophysiology, knowledge of health care delivery systems, understanding of acute/non‑acute care and common reimbursement methodologies. Demonstrated managerial/supervisory skills, leadership skills through collaborative practice, and time‑management skills to the satisfaction of the director.
• License and Certifications — Current RN license to practice in the state of California. CDS certification is preferred. A current American Heart Association BLS card is required.
• Equipment — Basic knowledge of computer systems.
• Physical Requirements — Must be able to perform essential physical job requirements.
• Pay Range — $62.84–$94.26.
  The posted pay range reflects the lowest to highest pay that was available for this position at the time of posting and may be subject to change. Salary offers are determined by candidate’s relevant experience and skills. For per diem positions, a standard rate is used based on market data and not the candidate’s individual experience.