Case Manager – Utilization Management

McLeod Health

. Oversee the process of care delivered to patients and provide leadership to the healthcare team .

Posted 10/5/2026full-timeRemote • South Carolina • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in patient care coordination, ensuring high-quality and efficient care delivery while optimizing reimbursement processes. Strong ability to communicate effectively with patients, families, and healthcare teams to develop individualized care plans.

Highest-signal resume keywords

Registered Nurse LicenseAcute Care Hospital ExperiencePatient Care CoordinationUtilization Management CommunicationData Entry Skills

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Soft Skills

LeadershipCommunicationAdvocacyCollaboration

Certifications & Qualifications

Registered Nurse Certification

Industry Keywords

Patient CareMedical NecessityReimbursement OptimizationContinuum of CareCare PlansLength of Stay MonitoringEmergency Department

About the role

Key responsibilities & impact

Oversee the process of care delivered to patients and provide leadership to the healthcare team
Examine medical records, treatments, interventions, and levels of care for medical necessity and reimbursement optimization
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 and Case Management teams on level-of-care determinations and reimbursement
Work with the Physician Advisory team on concurrent denials and appropriate level of care before billing
Monitor patient flow through multidisciplinary rounds and implement process improvements to decrease delays
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 across the organization, 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