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About the role
Key responsibilities & impact- Lead and collaborate on care management operations across utilization review, acute and emergency department care, and ambulatory/community settings
- Oversee multiple disciplines across care sites within a market or region
- Collaborate with medical staff, nursing, clinical, and revenue cycle leaders to optimize patient care and financial performance
- Manage departmental services including social work, complex care planning, transitions of care, and utilization management
- Ensure compliance with state, national, and regulatory requirements
- Foster workforce development
- Shape enterprise-wide strategies for safe, high-quality, patient-centered, and equitable care
- Oversee staffing, escalations, barrier triage, and coordination with compliance and legal teams
- Drive patient satisfaction programs and mentor staff in service excellence
- Represent care management with healthcare executives, post-acute providers, multidisciplinary teams, and outreach programs
- Lead process improvement, quality assurance, strategic initiatives, KPI monitoring, and change management
- Implement best practices and optimize operational effectiveness
- Report to the Care Management Director
Requirements
What you’ll need- Current Registered Nurse (RN) license in state of practice OR Licensed Clinical Social Worker (LCSW)/Licensed Master of Social Work (LMSW) or applicable license in state of practice with relevant experience at this licensure
- Bachelor of Science in Nursing (BSN) OR Master of Social Work (MSW) from an accredited institution; degree verification required
- Care Management Certification within 24 months of hire or promotion
- Demonstrated care management experience
- Previous management experience in hospital care management, utilization review, ambulatory care management, ambulatory utilization review, or related area preferred
- Current resume including work history and relevant licenses or certifications
- Ability to work Monday through Friday, 8:00am–4:30pm, with possible weekend support for escalations
- Ability to travel to various locations for operational oversight and leadership support
- Ability to meet stated physical requirements, including patient transfers, lifting, walking, standing, and frequent computer use
Benefits
Comp & perks- Benefits eligible
- Generous benefits package covering wellness, health, security, connection, and engagement programs
- Remote work expectations and company equipment provisions for remote or hybrid roles