Case Management Team Lead

Tampa General Hospital•Tampa, FL

About The Position

Under the general supervision of the Department Manager and in accordance with established policies, procedures, and professional guidelines, the Case Management Team Lead provides clinical leadership and operational support to the Case Management Department. The role coordinates daily departmental activities, including staffing, scheduling, and workflow, to support safe, efficient, and compliant care coordination services. The Team Lead provides hands-on mentorship, side-by-side support, and skill development for team members, promoting collaboration across departmental disciplines and interdisciplinary partners. The role identifies strengths, trends, and opportunities in clinical practice, escalates process-improvement opportunities to leadership, and applies problem-solving skills to support real-time intervention. It guides staff on medical necessity criteria, service appropriateness, and timely payer authorizations, and serves as an escalation resource for complex clinical, authorization, discharge, or payer-related issues. Duties are performed in alignment with Tampa General Hospital's mission, vision, values, and service excellence standards.

Requirements

Bachelor of Science in Nursing required, or an Associate degree in Nursing with a nursing certification.
Three years of clinical experience.
One year of experience in Utilization Management or Case Management, or two years in Emergency Management.
Ability to read, write, and speak English clearly and distinctly.
Knowledge of Microsoft Office, including Word, Excel, and PowerPoint.
Comprehensive knowledge of case management and utilization management, including care progression, discharge planning, authorization processes, and medical necessity management across Medicare, Medicaid, managed care, and commercial payer types.
In-depth experience applying InterQual® or similar nationally recognized medical necessity criteria to evaluate appropriateness of admissions, continued stays, services, and level-of-care determinations.
Ability to apply advanced clinical expertise and utilization management principles to evaluate services, resolve barriers to care, and support patient, quality, and organizational outcomes.
Knowledge of federal, state, local, and payer regulatory requirements related to utilization review, reimbursement, discharge planning, care coordination, and compliance.
Ability to mentor, coach, and support team members through side-by-side guidance, skill development, and performance feedback.
Ability to coordinate daily staffing, scheduling, and workflow; manage competing priorities; monitor workload distribution; and maintain departmental efficiency across UM and/or CM functions.
Strong communication and collaboration skills when working with physicians, interdisciplinary teams, patients, families, payers, and leadership.
Proficiency in Microsoft applications, including Outlook, Teams, Word, and Excel, to support communication, scheduling, documentation, reporting, data tracking, and operational coordination.
Ability to use electronic medical records, utilization management systems, and reporting tools for clinical decision-making, workflow oversight, and accurate, timely documentation.

Responsibilities

Oversee daily staffing, scheduling, and workflow to ensure appropriate coverage and continuity of utilization and case management services.
Provide side-by-side support, mentorship, and skill development to team members to promote clinical excellence, consistency, and adherence to utilization and care coordination standards.
Ensure team members perform duties in accordance with professional standards, hospital policies, payer requirements, and regulatory guidelines.
Guide staff in interpreting medical necessity criteria, evaluating appropriateness of services, and obtaining timely authorizations from managed and commercial payers.
Serve as an escalation resource for complex clinical, authorization, discharge, or payer-related issues and support resolution before leadership involvement.
Identify trends, strengths, and improvement opportunities in clinical practice and workflow and escalate themes to departmental leadership.
Apply critical thinking and problem-solving skills to address workflow challenges, clinical barriers, and payer issues in real time.
Promote collaboration among physicians, nursing, social work, finance, and ancillary departments to support safe, timely patient care transitions.
Arrange staff coverage as needed and provide direct coverage when necessary to meet patient care demands.
Support onboarding, orientation, and ongoing education of new employees, students, and assigned personnel.
Demonstrate professionalism, accountability, teamwork, and customer service while applying Tampa General Hospital service excellence standards of AKTiVe principles.
Actively seek opportunities to serve as the Case Management representative in hospital initiatives and cross-departmental meetings.