Manager - Case Management

Vetted Solutions; Florida; On-site; USD 85,000 - 105,000; Full time

Job summary

Vetted Solutions is seeking an experienced nurse case manager to oversee daily case management and discharge planning. You will lead discharge workflows, collaborate with multidisciplinary teams, and ensure adherence to regulatory standards.

The role requires leadership experience, strong clinical judgment, and the ability to implement performance improvements in a fast-paced hospital setting in Florida.

Qualifications

• Bachelor level nursing degree with case management focus preferred.
• Certification in case management is advantageous.
• Ability to apply evidence-based guidelines in patient care and discharge planning.

Responsibilities

• Oversee day-to-day case management and discharge planning activities.
• Collaborate with multi-disciplinary teams to optimize patient flow and compliance.
• Apply clinical decision-making using guidelines such as Interqual or Milliman.
• Lead process-improvement initiatives and monitor performance.

Skills

Leadership

Critical thinking

Communication

Decisive judgment

Independence under pressure

Payer guidelines

Regulatory knowledge

Performance improvement

Education

BSN or accredited nursing program

Case management certification (preferred)

Job description

Role Overview

Responsible for overseeing day-to-day case management and discharge planning functions to ensure high-quality, efficient patient care aligned with regulatory standards.

Key Responsibilities

Collaborate with multi-disciplinary teams to optimize patient flow, ensure compliance with State and Federal discharge planning regulations, and utilize hospital information systems. Apply clinical decision-making skills, medical criteria, and guidelines such as Interqual or Milliman. Lead process improvement initiatives, monitor performance, and support staff development.

Qualifications & Skills

Minimum of three years of case management experience, including two years in leadership roles. Graduate of an accredited nursing program or hold a BSN; case management certification preferred. Must demonstrate critical thinking, effective communication, decisive judgment, and ability to work independently in a stressful environment. Knowledge of payer guidelines, regulatory requirements, and performance improvement processes is essential.