Case Manager – Utilization Management

McLeod Health

. Oversee the process of care delivered to patients .

Posted 10/8/2026full-timeRemote • South Carolina • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in patient care coordination, ensuring high-quality, efficient, and cost-effective services while effectively communicating with patients, families, and healthcare teams. Proficient in assessing treatment appropriateness and managing discharge planning to optimize patient outcomes.

Highest-signal resume keywords

Registered Nurse LicenseAcute Care Hospital ExperiencePatient Care CoordinationDischarge PlanningUtilization Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryPatient AssessmentCare Plan DevelopmentTreatment Effectiveness EvaluationLength of Stay Monitoring

Soft Skills

LeadershipCollaborationCommunicationAdvocacyProblem-Solving

Certifications & Qualifications

Registered Nurse Certification

Industry Keywords

Patient CareReimbursement OptimizationMultidisciplinary RoundsEmergency DepartmentCase Management

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 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, taking action for continuous improvement
Communicate with Utilization Management/Case Management teams regarding level-of-care determination and reimbursement
Work with the Physician Advisory team on concurrent denials
Monitor patient flow through multidisciplinary rounds and help implement process improvements
Advocate for Emergency Department patients by identifying needs and coordinating services and resources
Communicate plan-of-care elements to patients, families, and healthcare team members
Cover various patient populations, including the Emergency Department
Perform other duties as 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