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Posted: 10/20/2026Case Manager – Utilization Management
McLeod HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient care coordination, discharge planning, and reimbursement optimization while ensuring high-quality, efficient, and patient-focused care. Proficient in collaborating with multidisciplinary teams and advocating for patient needs across various healthcare settings.
Highest-signal resume keywords
Registered Nurse LicenseAcute Care Hospital ExperiencePatient Care CoordinationDischarge PlanningReimbursement Optimization
About the role
Key responsibilities & impact- Oversee the process of care delivered to patients
- Work collaboratively and provide leadership to the healthcare team
- Examine records for medical treatments and interventions to avoid payment denial and optimize reimbursement
- Assess appropriateness of treatments, effectiveness, timing, and care setting
- Determine observation versus inpatient level of care based on medical necessity
- Assess patients for discharge planning and appropriateness of level of care
- Minimize and assist with barriers to discharge
- Coordinate and facilitate patient care progression throughout the continuum of care
- Ensure care plans and services are patient-focused, high quality, efficient, and cost-effective
- Meet with patients and families to assess needs and develop individualized continuing care plans with physicians
- Monitor length of stay and ancillary resource use and take actions for continuous improvement
- Communicate with Utilization Management, Case Management, and Physician Advisory teams regarding level-of-care determinations, reimbursement, and concurrent denials
- Monitor patient flow through multidisciplinary rounds and implement processes to decrease delays
- Advocate for Emergency Department patients by identifying needs and coordinating services and resources
- Ensure critical plan-of-care information is communicated to patients, families, and healthcare team members
- Perform other duties requested by the Case Manager Supervisor and/or Director
Requirements
What you’ll need- 1-2 years of recent acute care hospital experience required
- Data entry/computer experience required
- Registered Nurse license/certification required
- Ability to cover various populations across the organization, including the Emergency Department
Benefits
Comp & perks- Part-time schedule
- Equal opportunity employer
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data EntryPatient AssessmentCare Plan DevelopmentLength of Stay MonitoringUtilization Management Communication
Soft Skills
LeadershipCollaborationAdvocacyCommunicationProblem-Solving
Certifications & Qualifications
Registered Nurse Certification
Industry Keywords
Acute CareEmergency DepartmentPatient FlowMultidisciplinary RoundsCare Setting Appropriateness