RN Manager, Case Management Services

CCN Pharmacy; Pittsburgh (Allegheny County); On-site; USD 75,000 - 90,000; Full time

Job summary

CCN Pharmacy is seeking an RN Manager for Case Management Services located in Pittsburgh, PA. This role involves leading a clinical team to ensure high-quality patient care and compliance with regulations. The RN Manager will oversee case managers, develop clinical programs, and participate in quality assurance activities. A minimum of 3–5 years in clinical settings is required, with significant experience in managing specialty medication cases. Strong leadership and communication skills are essential to succeed in this position.

Qualifications

• Minimum of 3–5 years of clinical experience; case management experience preferred.
• Experience with specialty medication populations (e.g., HIV, Hepatitis C) is a plus.
• Strong understanding of healthcare regulations and patient care coordination.

Responsibilities

• Provide leadership, oversight, and management of the Case Management department.
• Develop and implement clinical programs supporting patient engagement and quality.
• Ensure accurate documentation for utilization and patient care.

Skills

Clinical assessment and care coordination

Leadership and staff development

Workflow optimization and process improvement

Strong interpersonal and relationship-building skills

Proficiency in EMR systems and Microsoft Office Suite

Education

Registered Nurse (RN) with an active license

Tools

EMR systems

Microsoft Office Suite

Job description

Position Summary

The RN Manager, Case Management Services provides leadership, clinical oversight, and operational management for the Case Management department. This role ensures high‑quality patient care, regulatory compliance, and efficient workflows while supporting the organization’s mission and strategic initiatives. The Manager oversees case managers, leads training and development, and serves as a clinical resource for patients, providers, and internal teams.

Essential Functions & Responsibilities

Department Leadership & Oversight

• Responsible for the appropriate training, education, supervision, and performance management of the Case Management department.
• Interprets and communicates regulations, policies, procedures, and organizational objectives to ensure consistent understanding and compliance across the team.
• Redesigns workflows and procedures to improve quality of service, enhance patient outcomes, and increase departmental efficiency and productivity.
• Periodically shadows Case Managers during assessments to ensure proper procedures are followed and exceptional services are delivered.

Clinical Program Development & Covered Entity Collaboration

• Leads the development, implementation, and optimization of clinical programs that support specialty medication management, patient engagement, and overall clinical quality.
• Collaborates with covered entities to design, refine, and expand clinical services that meet patient needs, provide education, and align with organizational goals.
• Partners with internal leadership and covered entity stakeholders to identify service gaps, propose enhancements, and support strategic initiatives that strengthen clinical program performance.

Clinical Responsibilities

• Conducts clinical assessments and provides oversight for patients on specialty medication regimens, including but not limited to HIV and Hepatitis C.
• Educates and evaluates patients regarding their treatment plans, adherence, and progress.
• Serves as an intermediary between patients and providers, supporting patient understanding of treatment plans and ensuring continuity of care.
• Collaborates with providers and their staff to share assessment information, confirm adherence, and report contraindications or concerns requiring modification of treatment.

Quality Assurance & Documentation

• Participates in chart reviews for utilization, documentation accuracy, and clinical appropriateness, ensuring timely follow‑up, intervention, and resource management.
• Ensures all patient activity is documented accurately and completely to support seamless reporting to providers, pharmacy staff, and contractual partners.
• Maintains continuous communication with all parties involved in patient care to monitor progress, resolve barriers, and advance case activity.

Cross‑Functional Collaboration

• Works closely with Business Development and Account Management teams to support demonstrations, program implementations, and client‑facing initiatives.
• Partners with internal departments to ensure alignment between case management workflows and broader organizational operations.

Other Responsibilities

• Participates in departmental meetings, quality improvement initiatives, and strategic planning activities as assigned.
• Performs all other duties as assigned by the Supervisor or Director.

Education & Experience Requirements

• Registered Nurse (RN) with an active, unrestricted license.
• Minimum of 3–5 years of clinical experience; case management experience strongly preferred.
• Experience working with specialty medication populations (HIV, Hepatitis C, or similar) is a plus.
• Demonstrated ability to lead, train, and mentor clinical and non‑clinical staff.
• Strong understanding of healthcare regulations, documentation standards, and patient care coordination.
• Excellent communication, critical thinking, and organizational skills.

Skills & Competencies

• Clinical assessment and care coordination
• Leadership and staff development
• Workflow optimization and process improvement
• Strong interpersonal and relationship‑building skills
• Ability to work independently and collaboratively
• Proficiency in EMR systems and Microsoft Office Suite

Physical Requirements / Working Conditions

• Ability to walk, stand, sit, and reach frequently.
• Ability to utilize standard office and clinical equipment including telephone, computer, printers, and designated software.
• Occasional travel (up to 10%) for home visits, meetings, or trainings.
• Must present a professional image and demonstrate behaviors that reflect competence, reliability, self‑control, and respect for others.
• Maintains a safe, clean, and professional work environment.