Nurse Manager, Care Management

Job Summary

Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, a...