Clinical Case Manager: Care Coordination & Quality Outcomes

Cullman Regional Medical Center, Inc.; Alabama; On-site; USD 85,000 - 105,000; Full time

Job summary

Cullman Regional Medical Center, Inc. is seeking a Nurse Case Manager to coordinate multidisciplinary care, facilitate precertification, and lead utilization review initiatives. You will work with physicians, nurses, social workers, and other health professionals to ensure cost-effective care and adherence to clinical guidelines.

The role emphasizes leadership in quality improvement, patient safety, and exceptional patient experiences within an acute care setting.

Qualifications

• Associate degree in nursing or higher; Alabama license required.
• Five years of clinical experience in acute care settings (medical-surgical, ICU, ER, OR).
• Experience in Utilization Review is preferred.
• Familiar with CMS Guidelines and navigating payor portals.
• Excellent organizational and communication skills.

Responsibilities

• 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 caseload.
• Facilitate precertification and payor authorization processes and collaborative management across the continuum.
• Promote effective utilization and monitoring of healthcare resources and adherence to evidence-based guidelines.
• Lead quality improvement activities related to quality measure initiatives and patient safety.
• Demonstrate and encourage teamwork and exceptional patient experiences.

Skills

Advanced communication

Interpersonal skills

Microsoft Word

Excel

CMS guidelines knowledge

Education

Associate degree in nursing (ADN)

BSN preferred

Tools

Payor portals

CMS guidelines

Job description

Cullman Regional Medical Center, Inc. is seeking a Nurse Case Manager to coordinate multidisciplinary care, facilitate precertification, and lead utilization review initiatives. You will work with physicians, nurses, social workers, and other health professionals to ensure cost-effective care and adherence to clinical guidelines.

The role emphasizes leadership in quality improvement, patient safety, and exceptional patient experiences within an acute care setting.