CASE MANAGER FT (13195)

Cullman Regional; Cullman (AL); On-site; USD 75,000 - 105,000; Full time

Job summary

Cullman Regional is seeking a Nurse in a Utilization Review/Case Management role to coordinate with physicians, nurses and social workers to expedite medically appropriate, cost-effective care and manage a designated patient caseload.

The position emphasizes leading quality improvement activities, ensuring adherence to clinical guidelines, and promoting patient safety and exceptional experiences across the care team.

Qualifications

• Nursing degree and Alabama license; BSN preferred.
• Minimum five years' clinical experience in acute care.
• At least one year in Utilization Review with JIVA/Interqual/Cerner/payors.
• Strong communication, interpersonal and organizational skills.

Responsibilities

• Coordinate with physicians, nurses, social workers and health team to expedite appropriate care.
• Support physicians with patient care, managing designated caseload.
• Facilitate precertification and payor authorizations and collaborate across care continuum.
• Lead quality improvement activities and ensure adherence to guidelines.
• Promote efficient resource use and maintain patient safety and outcomes.
• Demonstrate teamwork and deliver exceptional patient experiences.

Skills

Case management

Advanced communication

Organization

Microsoft Word

Excel

Education

Associate’s degree in nursing or higher

BSN preferred

Tools

JIVA

Interqual

Cerner

Microsoft Word

Excel

Job description

Job Details

Job Location: Cullman Regional Medical Center – Cullman, AL 35056
Position Type: Full Time
Job Shift: Day
Job Category: Nurse

Job Summary

• Coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost‑effective care.
• Support physician provision of patient care with accountability for designated patient case load.
• Facilitate precertification and payor authorization processes and facilitate collaborative management of patient care across the continuum, intervening as necessary.
• Promote effective utilization and monitoring of healthcare resources and assume a leadership role with the multidisciplinary team to achieve optimal clinical and resource outcomes.
• Apply process improvement methodologies in evaluating outcomes of care.
• Maintain and ensure adherence to clinical guidelines, tools and protocols based on evidence‑based medicine related to quality measure indicators.
• Assume leadership role in coordinating quality improvement activities related to quality measure initiatives.
• Demonstrate and encourage team behavior and exceptional patient/guest experiences.
• Uphold and promote patient safety and quality.

Qualifications

• Associate’s degree in nursing or higher degree required; currently licensed by the state of Alabama. BSN preferred.

Experience

• Five years’ clinical experience in acute care setting (e.g., medical surgery, critical care, ER, OR) required.
• One year experience in Utilization Review with JIVA, Interqual, Cerner, Medicare, HMOs, and other payors.

Additional Skills/Abilities

• Skill and proficiency in applying highly technical principles, concepts and techniques central to case management.
• Advanced communication and interpersonal skills with all levels of internal and external customers.
• Proficient in Microsoft Word and Excel.
• Excellent organizational skills; able to set priorities appropriately and handle multiple issues concurrently.