Registered Nurse - (RN) - Case Manager - Supervisor

Northeast Georgia Health System•Braselton, GA

About The Position

The Registered Nurse Case Manager Supervisor supervises the day-to-day clinical operations of case management and the interdisciplinary healthcare team to facilitate patient care throughout the care continuum. The role monitors case management activities and supports the education, competency, and accountability of licensed staff. It identifies key performance indicators and ensures professional and organizational standards are maintained. The employee performs clinical duties in accordance with population-specific guidelines and National Patient Safety Goals, and provides cross-coverage in all care settings as required, including weekend rotation when required. The supervisor oversees case management staff and serves as a clinical resource on utilization review policies, procedures, and government insurance programs. The position develops and maintains policies and procedures, supports recruiting and onboarding, trains staff, conducts quality audits, establishes performance expectations, reviews departmental reports, and addresses performance through feedback, counseling, and disciplinary action. It also manages payroll and staffing allocations for the utilization review team. The role collaborates with case management, physicians, hospital personnel, and departments such as Managed Care, Patient Financial Services, and Patient Access to support utilization review, reimbursement, continuity of care, and effective transitions from admission through discharge. It contributes to process improvement and quality outcomes through the Daily Management System Quest for Excellence initiative and leads daily team huddles.

Requirements

Current Georgia RN license.
Associate degree.
Experience in at least one major component of Case Management, Utilization Management, or Discharge Planning, or previous Case Manager experience.
Experience working with third-party payers and physicians.
Knowledge of healthcare federal and state regulations.
Excellent written and verbal communication skills and 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 utilization review standards and reimbursement.
Strong computer skills, including Microsoft Office, Excel, and Word, with the 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 the principles and practices of discharge planning, utilization review, and quality assurance or improvement.
Detail-oriented and able to work independently, organize work, prioritize multiple issues and projects, and meet defined timeframes.

Nice To Haves

Previous management or supervisory experience.
CCM (Case Management Certification) or ACM (American Case Management Certification).
Bachelor's degree in Nursing, Business Health, Management, or a related field, or a master's degree in Social Work.
Experience in the Case Management area of 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 as a resource for administrators and contracted vendors.
Develop, update, maintain, and communicate Case Management policies and procedures to support reimbursement and organizational goals.
Assist with recruiting, onboarding, orientation, and ongoing training of employees.
Develop and perform monthly quality audits of Case Management staff work.
Assist in establishing staff performance expectations, metrics, and goals; communicate standards and hold staff accountable.
Review daily, weekly, and monthly reports, assess performance against KPI standards, identify trends, make adjustments, and keep leadership and staff informed.
Build effective working relationships with Case Management and other departments, including Managed Care, Patient Financial Services, and Patient Access.
Collaborate with medical staff and hospital personnel to support effective transition planning from admission to discharge.
Communicate with and educate physicians on discharge planning policies, practices, and procedures.
Provide staff counseling and disciplinary action as necessary.
Conduct staff performance evaluations and provide clear, accurate, and objective feedback in accordance with NGHS policies and guidelines.
Manage employee payroll for the utilization review team and ensure timely, accurate administration.
Assess departmental workload and allocate staff 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 an upbeat, positive, and professional manner.
Provide cross-coverage in care settings as required, including weekend rotation when required.