Company Overview AdventHealth is a faith-based health care organization committed to providing comprehensive, compassionate care across the nation. With a focus on whole-person health, the organization operates numerous hospital campuses, home health agencies, and hospice services dedicated to serving diverse communities with excellence and integrity. Job Overview We are seeking a highly skilled and dynamic RN Manager of Case Management to lead our clinical case management team. The ideal candidate will possess extensive nursing experience within acute care settings, including trauma centers and specialized units such as ICU, pediatrics, or behavioral health. This leadership role requires a strategic thinker with expertise in healthcare management, regulatory compliance, and interdisciplinary team coordination. The RN Manager will oversee patient care planning, discharge processes, utilization review, and ensure adherence to industry standards such as NCQA and HIPAA regulations. Responsibilities Lead and supervise the clinical case management team to deliver exceptional patient-centered care across various settings including hospital, home health, and hospice. Develop and implement comprehensive care plans that align with clinical best practices, regulatory standards, and organizational policies. Oversee utilization review processes to optimize resource use while maintaining quality standards for Medicare, Medicaid, and managed care programs. Ensure accurate documentation review and medical records management in compliance with HIPAA and other healthcare regulations. Coordinate discharge planning efforts by collaborating with physicians, social workers, behavioral health specialists, and other healthcare professionals. Monitor team performance through data collection and analysis to improve patient outcomes and operational efficiency. Maintain current knowledge of healthcare policies related to acute care, trauma centers (Level I & II), pediatric units (PICU), addiction counseling, behavioral health services, and hospital medicine. Foster a collaborative environment that promotes professional development, leadership growth, and adherence to NCQA standards. Skills Extensive nursing background with experience in Level I & II trauma centers, ICU, pediatrics (PICU), behavioral health, or hospital medicine. Proven management skills with demonstrated success in supervising multidisciplinary teams within complex healthcare environments. Strong understanding of healthcare regulations including HIPAA, Medicare/Medicaid policies, and NCQA accreditation standards. Expertise in clinical case management practices such as discharge planning, utilization review, medical documentation review, and medical terminology proficiency. Knowledge of managed care operations along with experience managing patients as a nurse case manager in acute or post-acute settings. Excellent leadership abilities combined with effective communication skills for team management and stakeholder engagement. Familiarity with social work principles, behavioral therapy techniques, physiology and anatomy knowledge relevant to patient assessment. Ability to analyze data for quality improvement initiatives while ensuring compliance with healthcare policies related to behavioral health and social services. Join us in leading innovative case management initiatives that enhance patient outcomes while upholding the highest standards of clinical excellence!

Pay:

$78,540.80 - $146,078.40 per year

Benefits:

Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid time off Retirement plan Tuition reimbursement Vision insurance

Experience:

Case management: 3 years (Required) acute care

RN:

2 years (Required)

License/Certification:

RN License (Required)

Work Location:

In person