RN Manager - Case Management, Full-Time (Onsite)

Surgery Partners, Inc.; Addison, Northern (TX, KY); Hybrid; USD 95,000 - 135,000; Full time

Job summary

Manager of Case Management at Surgery Partners, Inc. leads the case management team with a strong focus on utilization review, ensuring compliant care and reducing unnecessary hospital stays. This role collaborates across departments to optimize care coordination and outcomes.

Requirements include RN license with BSN, UR/UR-related credentials, and 3+ years hospital-based case management experience. Proficiency with EPIC and payer policies is preferred; leadership and communication skills are

Qualifications

• RN license with BSN is required.
• CCM or ACM certification strongly preferred.
• Familiarity with EPIC and MCG Indicia preferred.
• Minimum 3 years of case management experience in a hospital setting.
• Understand CMS guidelines and payer policies.
• Ability to use InterQual or Milliman for level-of-care decisions.
• Knowledge of coding principles and chargemaster operations.
• Strong communication, organization, and teamwork; supervisory experience preferred.

Responsibilities

• Lead, mentor, and manage the case management team.
• Develop and implement policies to improve efficiency and regulatory compliance.
• Conduct performance evaluations and provide professional development.
• Oversee utilization review to ensure appropriate use of healthcare services.
• Ensure CMS and commercial payer requirements compliance.
• Analyze data to identify trends and recommend process improvements.
• Facilitate transitions of care across the continuum (inpatient, outpatient, home health).
• Collaborate with physicians and clinicians to develop patient-centered care.
• Facilitate discharge planning and care coordination.
• Monitor KPIs (readmissions, LOS, denial management) and regulatory forms.
• Ensure adherence to accreditation standards (DNV, COP) and keep updated on regulations.
• Serve as liaison between case management, clinical staff, and leadership.

Skills

Case management leadership

Utilization Review

CMS guidelines knowledge

InterQual/Milliman

EPIC

Communication skills

Team leadership

Organizational skills

Education

BSN

Tools

EPIC EMR

MCG Indicia

InterQual/Milliman

Job description

Job Category: Managed Care

Requisition Number: RNMAN036206

• Full-Time


• On-site

Locations

Showing 1 location

Methodist Hospital for Surgery
17101 Dallas Pkwy
Addison, TX 75001, USA

Description

GENERAL SUMMARY OF DUTIES:

We are seeking an experienced and dynamic Registered Nurse (RN) to lead our Case Management team, with a strong focus on Utilization Review. The Manager of Case Management will oversee the daily operations of the case management department, ensuring efficient utilization management, compliance with regulatory requirements, and optimal patient care outcomes. This role requires a strategic thinker who can collaborate across departments and with medical staff to improve care coordination and reduce unnecessary hospital stays.

REQUIREMENTS:

• RN license required with BSN

Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred

Familiarity with EPIC and MCG Indicia preferred

• Minimum of 3 years of previous case management experience is required in a hospital setting


• Understands the importance of teamwork when achieving desired results


• Understands basic CMS guidelines and has experience working with payor specific medical policies and reimbursement methodologies


• Understands how to use InterQual or Milliman to determine the appropriate level of care


• Understands basic coding principles and chargemaster operations


• Ability to be assertive with persuasive communication skills; action oriented


• Ability to be organized and efficient with time


• Ability to be compassionate to people and their situations to work with them in a positive way that will help them make positive forward strides


• Critical thinking skills, decisive judgment, and the ability to work with minimal supervision while meeting firm deadlines


• Communication skills necessary to be a good listener and speak in an understandable way


• Previous supervisory experience preferred

ESSENTIAL FUNCTIONS:

Leadership and Team Management

• Lead, mentor, and manage the small case management team


• Develop, maintain, and implement policies and procedures to improve departmental efficiency and compliance with regulatory agencies


• Conduct regular performance evaluations and provide professional development opportunities

Utilization Review and Compliance

• Oversee the utilization review process to ensure appropriate use of healthcare services


• Ensure compliance with Medicare and commercial payer requirements


• Analyze data to identify trends in utilization and recommend process improvements

Care Coordination and Case Management

• Facilitate seamless transitions of care across the continuum (e.g., inpatient, outpatient, home health)


• Collaborate with physicians, nurses, and other healthcare professionals to develop and implement patient-centered care


• Facilitate the discharge planning process for our patient population

Data Analysis and Reporting

• Monitor and report on key performance indicators (KPIs), including readmission rates, length of stay (LOS), and denial management


• Monitor and maintain regulatory forms (e.g., IMM, MOON)

Regulatory Compliance and Accreditation

• Ensure department adherence to DNV standards, CMS Condition of Participation, and other accrediting bodies


• Stay updated on changes in healthcare regulations and payer policies

Interdisciplinary Collaboration

• Serve as a liaison between case management, clinical staff, and administrative leadership


• Participate in hospital committees and quality improvement initiatives

PHYSICAL DEMANDS:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


• While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.


• The employee must be able to lift and/or carry 15 pounds on an occasional basis and be able to push/pull 5 pounds on an occasional basis.


• The employee must be able to stand and/or walk at least five hours per day

WORK ENVIRONMENT:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.