Registered Nurse - (RN) - Case Manager - Supervisor

nghs; Braselton (GA); In loco; USD 90.000 - 120.000; Tempo pieno

Descrizione del lavoro

nghs Nursing in Georgia seeks a Nursing - Registered Nurse supervisor to lead the day‑to‑day operations of Case Management and the interdisciplinary team, guiding education, compliance, and performance with KPIs. The role ensures patient care across the continuum and adherence to safety goals.

You will mentor staff, manage workflows, collaborate with Managed Care and physicians, and uphold federal/state regulations while optimizing utilization and reimbursement.

Competenze

• GA licensed RN and current license to practice in Georgia.
• Associate degree in Nursing required.
• Experience in case management, utilization management or discharge planning preferred.

Mansioni

• Supervises day‑to‑day operations of Case Management staff.
• Serves as clinical resource for UR policies and government programs.
• Develops and communicates CM policies to support reimbursement and patient care.
• Participates in recruiting, onboarding and professional development of staff.
• Reviews performance metrics and ensures KPI targets are met.
• Collaborates with Managed Care, Patient Financial Services and other departments.

Descrizione del lavoro

Job Category:

Nursing - Registered Nurse

Work Shift/Schedule:

8 Hr Morning - Afternoon

About the Role:

Job Summary

Supervises the day-to-day clinical operations of the case manager and interdisciplinary healthcare team in facilitating patient care through the continuum. Monitors CM activities to ensure optimum case management, including education, competency and accountability of the licensed staff who provide services to patients. Responsible for identifying key performance indicators for the CM staff, ensuring all professional and organizational standards are kept and ensuring organizational and staff accountability. Employee performs clinical duties in accordance with population specific guidelines to National Patient Safety Goals as outlined in the policy and procedures. Provides cross coverage in all settings as required in the care continuum, including weekend rotation, when required.

Minimum Job Qualifications

• Licensure or other certifications: Currently GA licensed RN.
• Educational Requirements: Associate degree
• Minimum Experience: Previous management or supervisory experience preferred. Experience in at least one major component of Case Management, Utilization Management, Discharge Planning, previous Case Manager. Experience working with third party payers and Physicians. Experience and knowledge in healthcare Federal and State regulations is required.

Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: CCM (Case Management Certification) or ACM (American Case Management Certification) preferred.
• Preferred Educational Requirements: Bachelors Degree in Nursing, Business Health, Management, etc. or a Masters degree in Social Work.
• Preferred Experience: Experience of the Case Management area within a mid-large hospital (200+ beds) or 5 or more years' experience in hospital clinical/financial operations and management.

Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Excellent written and verbal communication skills with the ability to communicate effectively and diplomatically with multi-disciplinary team.
• Supervisory or managerial experience including hiring, training, coaching, and counseling of employees.
• Experience in developing processes, standard workflows, procedures and policies that positively impact efficient utilization review standards and reimbursement.
• Strong computer skills with the ability to use Microsoft Office, including, but not limited to Microsoft Excel and Word; be able to create spreadsheets, review/sort data, create formulas and word processing.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage; knowledgeable of Federal and State regulations and hospital finance.
• Knowledgeable of Case Management models, including the principles and practices of discharge planning, utilization review, and quality assurance/improvement.
• Must be detail-oriented, able to work independently and possess strong organizational skills with the ability to prioritize multiple issues, tasks and projects while meeting defined timeframes.

Essential Tasks and Responsibilities

• Provides supervision of the day-to-day operations of Case Management staff
• Functions as a clinical resource for the department and internal staff, demonstrating a thorough knowledge of all Utilization Review policies, procedures, and government insurance programs. Also serves as a resource for administrators and contracted vendors.
• Develops, updates, maintains and communicates CM policies and procedures to ensure positive impact and reimbursement in accordance with the mission, values and strategic goals of the organization.
• Assists in the recruiting and onboarding of new hires, orients, and continuously trains employees to ensure success in their role and a thorough understanding of the necessary policies, processes, and procedures of the UR role.
• Develops and performs quality audits on CM staff to ensure accuracy of work on a monthly basis
• Assists in the development of staff performance expectations, metrics, and goals and holds self and staff accountable to achieving. Establishes and communicates performance and behavioral standards and follows the appropriate disciplinary courses of action when counseling staff. (Accountable to KPIs and metrics set by Sr. Management - see Key Performance Indicators section above)
• Reviews daily, weekly and monthly reports to monitor and analyze performance of department, assess data against KPI standards and goals, and identifies trends. Makes adjustments where needed. Keeps leadership, staff, and clinical staff (where appropriate) informed.
• Works closely with Case Management to ensure effective department collaboration. Identifies and maintains good relationships with other departments such as Managed Care, Patient Financial Services, Patient Access, and others so to facilitate the utilization