Case Management Manager – Clinical Resource / Utilization Management - CMMMC

Job Title: Manager, Clinical Resource/Case Management
Location: Remote
Type: Contract | 27 Weeks
Shift & Schedule: Monday – Friday | 8-Hour Day Shifts | Rotating On-Call for Weekends and Holidays

Pay Rate: $75 - $85/hour

Position Overview:

We are seeking a Manager, Clinical Resource Department to lead Case Management, Utilization Review, and Social Work in an acute care hospital. The role oversees discharge planning, care coordination, and compliance while driving operational efficiency, staff development, and process improvement in collaboration with interdisciplinary teams.

Responsibilities

• Manage day-to-day operations of the Case Management and Social Work teams, including staffing, scheduling, workflow oversight, and performance evaluations.

• Support Clinical Documentation Integrity initiatives and collaborate with operational leadership as needed.

• Conduct regular patient care unit rounds to identify barriers to discharge and facilitate timely transitions of care.

• Develop and deliver continuing education programs for Case Managers, Social Workers, and interdisciplinary team members.

• Coordinate onboarding and training programs for new staff, including Case Managers, Social Workers, trainees, physicians, nurses, and allied health professionals.

• Monitor departmental compliance metrics and create dashboards to identify performance trends and improvement opportunities.

• Lead process improvement initiatives related to utilization management, discharge planning, and care coordination.

• Mentor and coach staff while promoting collaborative practice across disciplines.

• Analyze departmental performance metrics and utilize data to drive operational excellence.

• Maintain current knowledge of CMS regulations, case management standards, and industry best practices.

• Support organizational quality initiatives and actively contribute to a culture of continuous improvement.

Required Qualifications

• Bachelor’s Degree in Nursing (BSN).

• Certification in Case Management (CCM) and/or Clinical Documentation Integrity (CDI).

• Current Massachusetts Registered Nurse (RN) License.

• Minimum 5 years of acute care Case Management experience.

• Minimum 3 years of acute care clinical experience within the last 5 years.

• Working knowledge of InterQual® or equivalent utilization review criteria.

• Experience with process improvement initiatives.

• Knowledge of CMS regulations and compliance requirements.

• Strong analytical, organizational, communication, and computer skills.

Preferred Qualifications

• Master’s Degree in Nursing or related healthcare field.

• Certification in Case Management (CCM) and/or Clinical Documentation Integrity (CDI).

• Previous leadership, management, or supervisory experience.

• Experience developing and presenting professional continuing education programs.

For more details contact at hdavda@navitashealth.com or Call / Text at 516-862-1169.

About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.