RN Manager: Case Management & Utilization Review

Littleton Regional Healthcare; Littleton (NH); On-site; USD 43,000 - 66,000; Full time

Job summary

Littleton Regional Healthcare seeks an experienced Manager of Case Management and Utilization Review (RN) to lead the Case Management department and ensure safe transitions of care. The role oversees discharge planning, utilization review, and related social services, driving effective resource use and regulatory compliance.

The manager will develop staff, analyze performance data, coordinate with providers and payers, and participate in quality and policy initiatives.

Qualifications

• RN license in NH, or multi-state license with NH privileges.
• BSN or related healthcare bachelor's preferred.
• ACCM/CCM certification preferred or achievable within 18 months.
• 2+ years in case management, utilization review or discharge planning.
• Knowledge of Medicare/Medicaid and payer requirements.
• Strong leadership, communication, data-analysis, and organizational skills.

Responsibilities

• Provides leadership and day-to-day management of utilization review and case management.
• Plans, develops, implements, and optimizes departmental programs and policies.
• Ensures timely assessment of patient needs and safe discharge planning.
• Oversees payer communication, authorization activities, and escalations.
• Maintains knowledge of Medicare, Medicaid, and payer requirements.
• Leads committees and presents reports on case management and utilization review.

Skills

Leadership

Communication

Problem Solving

Data Analysis

Organizational Skills

Conflict Resolution

Education

Bachelor of Science in Nursing

ACCM/CCM Certification

Tools

Electronic Health Records

Word Processing

Spreadsheets

Job description

Littleton Regional Healthcare seeks an experienced Manager of Case Management and Utilization Review (RN) to lead the Case Management department and ensure safe transitions of care. The role oversees discharge planning, utilization review, and related social services, driving effective resource use and regulatory compliance.

The manager will develop staff, analyze performance data, coordinate with providers and payers, and participate in quality and policy initiatives.