Registered Nurse - (RN) - Case Manager - Supervisor

Northeast Georgia Medical Center•Braselton, GA

About The Position

The Registered Nurse Case Manager Supervisor oversees day-to-day clinical operations of the case management and interdisciplinary healthcare teams, facilitating patient care across the continuum. The supervisor monitors case management activities and supports optimal practice through staff education, competency, accountability, and adherence to professional and organizational standards. The role identifies key performance indicators and ensures staff and organizational accountability. Clinical duties must follow population-specific guidelines and National Patient Safety Goals. Cross-coverage across care settings, including a weekend rotation when required, is part of the role. The supervisor serves as a clinical resource on utilization review policies, procedures, and government insurance programs; maintains and communicates case management policies and procedures; supports recruitment, onboarding, orientation, and continuous staff training; and oversees quality audits, performance expectations, reporting, staffing allocations, payroll, and employee evaluations. The position collaborates with physicians, hospital personnel, internal departments, administrators, and vendors to support utilization review, reimbursement, continuity of care, and safe transitions from admission through discharge. It also leads team huddles and participates in process-improvement efforts focused on reimbursement and quality outcomes.

Requirements

Currently licensed as an RN in Georgia.
Associate degree.
Experience in at least one major component of Case Management, Utilization Management, or Discharge Planning, or prior experience as a Case Manager.
Experience working with third-party payers and physicians.
Knowledge of healthcare Federal and State regulations is required.
Excellent written and verbal communication skills, including the ability to communicate effectively and diplomatically with a multidisciplinary team.
Supervisory or managerial experience, including hiring, training, coaching, and counseling employees.
Experience developing processes, standard workflows, procedures, and policies that positively affect efficient utilization review standards and reimbursement.
Strong computer skills, including Microsoft Office, Excel, and Word; ability to create spreadsheets, review and sort data, create formulas, and perform word processing.
Working knowledge of Medicare, Medicaid, HMO, and private insurance coverage criteria; Federal and State regulations; and hospital finance.
Knowledge of Case Management models and of discharge planning, utilization review, and quality assurance/improvement principles and practices.
Detail-oriented, able to work independently, and able to prioritize multiple issues, tasks, and projects while meeting defined timeframes.

Nice To Haves

Previous management or supervisory experience preferred.
CCM (Case Management Certification) or ACM (American Case Management Certification) preferred.
Bachelor’s degree in Nursing, Business Health, Management, or a related field, or a master’s degree in Social Work.
Experience in Case Management at a mid-to-large hospital (200+ beds), or five or more years of experience in hospital clinical/financial operations and management.

Responsibilities

Supervise the day-to-day operations of Case Management staff.
Serve as a clinical resource for the department and internal staff on Utilization Review policies, procedures, and government insurance programs, and provide support to administrators and contracted vendors.
Develop, update, maintain, and communicate Case Management policies and procedures.
Assist with recruiting and onboarding new hires, orienting employees, and providing continuous training.
Develop and perform monthly quality audits of Case Management staff work.
Assist in developing staff performance expectations, metrics, and goals, and hold staff accountable for achieving them.
Establish and communicate performance and behavioral standards, and take appropriate disciplinary action when needed.
Review daily, weekly, and monthly reports; assess performance against KPI standards and goals; identify trends; make adjustments; and keep relevant leaders and staff informed.
Work with Case Management and other departments, including Managed Care, Patient Financial Services, and Patient Access, to facilitate utilization review and continuity of care.
Collaborate with medical staff and hospital personnel on transition planning from admission to discharge.
Communicate with and educate physicians about discharge-planning policies, practices, and procedures to support safe and effective transitions of care.
Counsel employees, administer disciplinary action as necessary, and conduct performance evaluations with clear, accurate, objective feedback.
Manage employee payroll for the UR team and ensure timely and accurate administration.
Assess departmental workload and determine appropriate staffing allocations to meet productivity standards.
Work with physicians and staff to provide and monitor clinical and financial data to improve hospital and physician performance and anticipate payer and managed-care demands.
Participate in the Daily Management System Quest for Excellence initiative and lead process-improvement efforts to improve reimbursement and quality outcomes.
Lead daily team huddles in a positive and professional manner.
Perform clinical duties in accordance with population-specific guidelines and National Patient Safety Goals.
Provide cross-coverage in all care-continuum settings as required, including weekend rotation when required.