RN Case Management Supervisor

Jobtailor; South Carolina; On-site; USD 85,000 - 110,000; Full time

Job summary

Jobtailor is seeking a Nurse Manager to supervise utilization review, case management, and quality management programs. You will lead staff, identify training needs, and ensure accurate workflows while developing wellness and preventive programs.

Strong data analysis, reporting, and compliance with URAC/NCQA are essential. The ideal candidate has RN licensure in the US, related health experience, and recent leadership roles.

Qualifications

• Associate's degree required with nursing/healthcare focus.
• Active RN licensure in the United States.
• 5+ years of combined health promotion, health education, health insurance or related healthcare experience.
• Master’s degree: 3+ years of required experience applies.
• Case management certification is preferred.

Responsibilities

• Supervise and maintain daily functions across Utilization Review, Case Management, and Quality Management.
• Oversee day-to-day activities for assigned staff and identify training needs.
• Verify workflow accuracy and improve efficiency.
• Develop and oversee wellness, preventive, and employer work site programs.
• Approve staff time/leave and conduct performance reviews.
• Prepare and maintain weekly/monthly management reports and ensure URAC/NCQA compliance.

Skills

Data Analysis

Quality Control

Workflow Verification

Audit Procedures

Health Promotion

Health Education

Managed Care Knowledge

Insurance Programs Understanding

Program Development

Performance Review

Excellent Communication

Organizational Skills

Customer Service

Critical Thinking

Decision Making

Education

Associate's degree

Active RN Licensure (US)

LMSW Licensure

LISW Licensure

LPC Licensure

Master of Public Health / Healthcare Administration

Case Management Certification

Tools

Microsoft Office

Job description

• Supervise and maintain daily functions across Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or appeals
• Supervise day-to-day activities for assigned staff
• Identify staff training needs
• Verify workflow accuracy, efficiency, and effectiveness
• Develop and oversee specialty programs, including wellness, preventive, and/or employer work site programs
• Approve staff time and leave and conduct performance reviews
• Select, train, and motivate staff to provide excellent customer service
• Develop, maintain, and update audit procedures and documentation
• Develop and communicate department standards and staff expectations
• Perform quality control and develop work plans to improve quality performance
• Analyze program components and collect data for outcomes reporting
• Prepare, review, and maintain weekly/monthly management reports
• Oversee data collection and URAC/NCQA compliance activities
• Coordinate with corporate departments to ensure effective communication

Requirements

• Associate's in a job-related field
• Graduate of Accredited School of Nursing as a degree equivalency
• 5 years of combined health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare experience
• If Master’s Degree, 3 years of required experience
• One year experience in a team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent)
• Understanding of insurance and benefit programs as they relate to health management coverage
• Working knowledge of managed care and/or various forms of health care delivery systems
• Knowledge of specific criteria/protocol sets and their use
• Knowledge/understanding of the quality improvement process
• Ability to work independently, prioritize effectively, and make sound decisions
• Excellent communication skills
• Ability to work with a wide variety of internal and external customers
• Good judgment skills
• Demonstrated customer service, organizational, and presentation skills
• Demonstrated verbal and written communication skills
• Analytical, critical thinking, and math skills for collecting, analyzing, and reporting data
• Ability to persuade, negotiate, or influence others
• Ability to handle confidential or sensitive information with discretion
• Ability to direct, motivate, and assess performance of others
• Microsoft Office proficiency
• Active, unrestricted RN licensure from the United States and the state of hire, or active compact multistate unrestricted RN license under the Nurse Licensure Compact; alternatively, active unrestricted professional healthcare licensure/certification in the specialty, active unrestricted LMSW, LISW, or LPC licensure, or a Master's in Public Health/Healthcare Administration with three additional years of health-related experience
• Must obtain Case Management certification from a URAC accrediting body within 3 years of hire for non-Medicaid roles
• Preferred: at least 3 years of leadership experience at supervisor level or above in Care Management

Demonstrates expertise in Utilization Review, Case Management, and Quality Management, with a strong focus on staff supervision, training, and performance evaluation. Proficient in data analysis, compliance activities, and developing wellness programs to enhance health management outcomes.

Highest-signal resume keywords

• Utilization Review
• Case Management
• Quality Improvement Process
• Active RN Licensure
• Leadership Experience

ATS Optimization Keywords

Hard Skills

• Data Analysis
• Quality Control
• Workflow Verification
• Audit Procedures Development
• Health Promotion
• Health Education
• Managed Care Knowledge
• Insurance Programs Understanding
• Program Development
• Performance Review

Soft Skills

• Excellent Communication Skills
• Organizational Skills
• Customer Service Skills
• Critical Thinking
• Decision-Making

Certifications & Qualifications

• Case Management Certification
• Active Unrestricted RN Licensure
• LMSW Licensure
• LISW Licensure
• LPC Licensure

Industry Keywords

• Health Management
• Healthcare Delivery Systems
• URAC Compliance
• NCQA Compliance
• Wellness Programs

Tools & Technologies

• Microsoft Office