RN Manager - Case Mgt & Util Mgt
- Silver Spring, MD
- Permanent
- Full-time
Schedule: Full-TimePosition PurposeHoly Cross Health is seeking a dynamic and experienced RN Manager – Case Management & Utilization Management to lead our inpatient care coordination and utilization review team. Reporting to the Director of Care Management, this role is responsible for the operational management, leadership, professional development, and quality improvement activities of the RN Case Managers. The RN Manager ensures compliance with regulatory standards and supports the mission of Trinity Health and Holy Cross Hospital.What You Will Do
- Manage daily operations of RN Case Managers and serve as a clinical resource for the team.
- Conduct clinical supervision and support staff development.
- Collaborate with physicians, physician advisors, and external review organizations to ensure quality outcomes and efficient resource utilization.
- Attend daily huddles, weekly interdisciplinary team meetings, and administrative meetings.
- Monitor and ensure compliance with incident reporting procedures and regulatory requirements.
- Assist with denial prevention strategies and support staff in managing medical necessity denials.
- Maintain positive working relationships across departments to promote patient throughput and care coordination.
- Licensure/Certification:
- Active Registered Nurse license in the State of Maryland required.
- Education:
- Bachelor of Science in Nursing (BSN) required; Master of Science in Nursing (MSN) preferred.
- Experience:
- Minimum of 3 years in hospital case management or related field.
- 1–3 years of management, supervision, or leadership experience in an acute healthcare setting required.
- Extensive knowledge of payer mechanisms and clinical utilization management required.
- Preferred Qualifications:
- 5–7 years of clinical nursing experience in an acute care setting.
- Experience with designation changes, utilization review, and external review organizations.
- Strong interpersonal skills and ability to work effectively with interdisciplinary teams.
- Lead a high-performing team in a mission-driven healthcare organization.
- Play a key role in improving patient outcomes and operational efficiency.
- Opportunity for professional growth and leadership development.
- Comprehensive benefit packages available, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from first day of employment.
- Work/Life balance with flexible schedules.
- Free onsite parking.
- Our mission and core values are what drives each member of Holy Cross Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.