RN Case Management & Utilization Leader

Littleton Hospital Association; Littleton (NH); On-site; USD 43,000 - 66,000; Full time

Job summary

Littleton Regional Healthcare in Littleton, NH, is seeking a Manager of Case Management and Utilization Review (RN) to lead utilization review, discharge planning, and related social services. This working-manager role ensures safe transitions of care, appropriate levels of care, and compliant reimbursement while guiding the Case Management team.

The ideal candidate is a registered nurse with at least two years in case management or utilization management, strong leadership and data-analysis

Qualifications

• Graduate of an accredited Registered Nursing program.
• Current, unrestricted Registered Nurse license in New Hampshire.
• Minimum of two years in case management, utilization review, discharge planning, or related acute-care function.
• Knowledge of acute-care discharge planning, levels of care, and medical necessity.
• Experience with Medicare/Medicaid, managed care, and payer processes.
• Proficient with EHR and standard office software.

Responsibilities

• Provides leadership and day-to-day management of utilization review, case management, discharge planning, and related social service functions.
• Plans, develops, implements, evaluates and improves departmental programs and procedures.
• Ensures timely assessment of patient needs and coordinated discharge plans including post-acute care.
• Promotes patient- and family-centered care and facilitates communication among care teams.
• Oversees utilization review processes, authorizations, and escalation of concerns.
• Maintains knowledge of regulatory standards and payer requirements.
• Collects and analyzes data to evaluate resource utilization and department performance.
• Leads committees and participates in quality, accreditation, and improvement activities.

Skills

Leadership

Communication

Data analytics

Organizational skills

Problem solving

Education

RN licensure NH

BSN preferred

ACM/ CCM certification preferred

Tools

Electronic Health Records (EHR)

Office software (Word/Excel)

Job description

Littleton Regional Healthcare in Littleton, NH, is seeking a Manager of Case Management and Utilization Review (RN) to lead utilization review, discharge planning, and related social services. This working-manager role ensures safe transitions of care, appropriate levels of care, and compliant reimbursement while guiding the Case Management team.

The ideal candidate is a registered nurse with at least two years in case management or utilization management, strong leadership and data-analysis