RN Care Management & Utilization Leader

LCMC Health; United States; On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Equal opportunity employer

Community-focused culture

Employee recognition programs

Job summary

LCMC Health is seeking an RN Manager of Care Management to lead the Case/Care Management department, ensuring quality care, consistency, and ongoing improvement. The role prioritizes utilization review, case management, and coordinating duties of direct reports.

You will supervise staff, align policies with regulatory standards, and collaborate with other departments to resolve claims while maintaining departmental calendars and reviewing denials and appeals.

Qualifications

• Minimum 3 years in case management or management.
• Supervisory experience preferred.

Responsibilities

• Oversee day-to-day administration of the Care Management Department to ensure quality care and continuous improvement.
• Supervise staff responsible for care management and assist in orientation and performance reviews.
• Review and revise departmental policies and procedures.
• Monitor HIPAA compliance and regulatory standards (TJC, CMS).
• Represent department on hospital committees and coordinate with other departments.
• Coordinate and evaluate case management processes and resolve outstanding claims.
• Monitor utilization review and assign reviews to case managers.
• Assist with denials and appeals and monitor case work queues.
• Maintain department calendar and vacation/time-off requests.
• Serve as primary contact for revenue cycle staff and respond to referred cases.

Skills

Case management

Leadership

Education

RN license (Louisiana)

Certified Case Manager (preferred)

Job description

LCMC Health is seeking an RN Manager of Care Management to lead the Case/Care Management department, ensuring quality care, consistency, and ongoing improvement. The role prioritizes utilization review, case management, and coordinating duties of direct reports.

You will supervise staff, align policies with regulatory standards, and collaborate with other departments to resolve claims while maintaining departmental calendars and reviewing denials and appeals.