Lead Case Manager, Nurse

WVU Medicine

. Functions as a lead team member and fosters a positive and mentoring work environment .

Posted 11/9/2026full-timeOakland • Maryland • United StatesSenior💰 $73,715 - $110,573 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in patient transition and discharge planning, resource management, and multidisciplinary collaboration to ensure high-quality, efficient patient care. Possesses strong leadership skills to mentor staff and facilitate effective communication among care teams and families.

Highest-signal resume keywords

Registered Nurse LicensePatient Transition PlanningUtilization ManagementMultidisciplinary CollaborationDenial Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewsPatient AssessmentDischarge PlanningCare FacilitationMedical Necessity AssessmentDurable Medical Equipment KnowledgePayer Regulations EducationTransition Planning DocumentationWorkflow CoordinationIndividualized Care Plans

Soft Skills

MentoringCommunicationCollaborationLeadershipProblem-Solving

Tools & Technologies

Electronic Health RecordsQuality ScreensPatient Benefit Coordination Tools

Certifications & Qualifications

Registered Nurse LicenseBachelor’s Degree in Nursing (BSN) Preferred

Industry Keywords

Utilization CriteriaHealthcare Team IntegrationPatient-Focused CareFinancial Assistance CoordinationManaged Care Principles

About the role

Key responsibilities & impact

Functions as a lead team member and fosters a positive and mentoring work environment
Plans comprehensively for targeted patient populations
Performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge planning, care facilitation, and referral to other levels of care
Works collaboratively with the multidisciplinary care team to facilitate desired treatment outcomes
Provides oversight of staff
Provides support, expertise, and leadership to staff
Coordinates workflow, work assignments, and schedules
Manages transition and discharge planning for assigned patients
Collaborates with the multidisciplinary team to facilitate transition and discharge processes
Monitors patient progress and intervenes as necessary to ensure patient-focused, high-quality, efficient, and cost-effective care
Educates staff, physicians, patients, and families on transition planning
Meets with patients and families to assess needs and develop individualized transition and discharge plans with physician teams
Communicates complex family dynamics affecting patient care and transition planning
Initiates and facilitates referrals to homecare, durable medical equipment, hospice, long-term acute care, acute rehabilitation, and skilled nursing services
Communicates transition and discharge plan information to the care team, patients, and families
Documents patient and family interactions and transition and discharge planning activities
Assists with medical power of attorney, healthcare surrogate, and advance directive completion
Collaborates on financial assistance, entitlement program, and patient benefit coordination
Uses electronic-record quality screens to identify avoidable delays and readmissions
Completes clinical reviews
Applies utilization criteria to assess medical necessity of admissions and continued stays and documents findings
Screens for authorization and appropriate level of care
Facilitates covered-day reimbursement certification and resolves payer issues, including peer-to-peer discussions
Educates hospital staff and physicians on payer regulations and managed care principles to prevent denials
Fosters integration of staff and students into the healthcare team

Requirements

What you’ll need

Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
Seven (7) years clinical experience
Knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc
Knowledge of relevant scientific principles, established standards of care and/or research findings
Knowledge of procedures and techniques involved in administering routine and special treatments to patients
Knowledge of and appropriate application of the nursing process
Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling
Ability to lift, move, and position patients of all weights, with varying amounts of assistance
Hearing within a normal range
Visual acuity within normal range and ability to perform night driving as necessary for patient care
Ability to perform heavy work, exerting in excess of 100 pounds of force occasionally, up to 50 pounds frequently, and up to 20 pounds constantly
Ability to work closely with others, protracted or irregular hours, biohazards, infectious diseases, hands in water, and electrical hazards
Bachelor’s degree in Nursing (BSN) preferred

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Disability Coverage
Tuition Program
Retirement
Paid Time Off
Wellness Program