Nurse Manager (RN) Case Mangement

Position Summary

The Nurse Manager Case Management provides strategic and operational leadership for inpatient care coordination case management and utilization management services. This role partners with physicians hospital leadership and system stakeholders to ensure highquality costeffective patientcentered care while optimizing throughput length of stay and regulatory compliance.

Key Responsibilities

• Lead Care Coordination Case Management and Utilization Management teams including staff development performance management and engagement

• Promote evidencebased nursing practice patient safety and interdisciplinary collaboration

• Oversee utilization management processes levelofcare determinations concurrent reviews denials management and appeals

• Collaborate with Physician Advisors Finance Revenue Integrity Patient Access and Compliance teams

• Monitor CMS and payer compliance (IMM/MOON authorizations documentation standards)

• Drive patient flow initiatives to support timely admissions transitions of care and discharge planning

• Analyze data trends and outcomes to support quality improvement and financial stewardship

• Participate in hospital and systemwide committees and strategic initiatives

Required Qualifications

• Active Registered Nurse (RN) license in Pennsylvania

• BSN required; MSN or Masters in related field preferred

• Minimum 5 years of healthcare experience including leadership or management

• Experience in care coordination case management utilization management or patient flow

• Strong communication analytical and changeleadership skills

Preferred Qualifications

• Masters degree (MSN or related healthcare field)

• Experience in utilization management denial management and payer relations

• Prior leadership experience in a large health system or multidepartment environment

• Knowledge of CMS regulations payer requirements and care management best practices

About Us:St. Mary Medical Centeris a beautiful 53-acrestate-of-the-artfacilitycomprisedof more than 700 physiciansnearly 3000colleagues and 1100 volunteers committed to providing quality care delivered with compassion and . Mary attracts top doctors introducescutting-edgetechnologiesand implements advanced procedures to meet the healthcare needs of the people it serves including thenearly630000residentsof Bucks County.

Our Commitment

Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.