Nurse Manager, Care Management

About the role

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, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The Manager works collaboratively to build relationships with key internal and external stakeholders; provides education about CM program functions, payer, and regulatory requirements including current trends and potential impact on the department, hospital, or system. Works collaboratively with the Nurse Manager Command Center to ensure the Utilization Plan is met and there are smooth handoffs with medical necessity reviews.

Requirements

• Bachelor's Degree in Nursing, Healthcare, or related field (Required)
• Master's Degree (Preferred)
• Work Experience
• 3 or more years acute care case management (Required)
• 3 or more years supervisory and leadership experience with minimum of 2-3 years at manager level in comparable setting (Required)
• Licenses and Certifications
• Registered Nurse (RN) with current Georgia license (Required)
• Certified Case Manager (CCM), Accredited Case Manager (Required)
• Essential Functions
• Support Care Management activities in meeting standards consistent with fiscal, regulatory, clinical, and operational requirements including patient satisfaction.
• Assist Central Intake staff with challenging issues and provides appropriate guidance.
• Coordinate recruiting, hiring, and training of new staff; supports ongoing staff development and competencies; provides in-services and education in new requirements and initiatives.
• Assess compliance with policies and procedures; performs auditing functions and evaluates designated staff performance.
• Resource to physicians and other hospital staff regarding care management activities and changes.
• Work collaboratively with the Chief Utilization Officer to identify and manage high-risk and long-stay patient issues, address regulatory changes that impact physician practice, CM, and hospital operations; develop physician education regarding changes in payer and regulatory requirements.
• Support the CUO with Utilization Steering Committee coordination, preparation, agenda issues, and presentations.
• Maintain current with relevant Federal, State, and local laws, DNV standards, or re

Benefits

Additional Information

Job Number: 34295 Location: Phoebe Putney Memorial Hospital Street Address: 417 W 3rd Ave City, State: Albany, Georgia Zip Code: 31701 Department: PPMH CARE MANAGEMENT Shift: Days Job Type: Full time Posted Date: 2026-06-30 Job Description 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, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The Manager works collaboratively to build relationships with key internal and external stakeholders; provides education about CM program functions, payer, and regulatory requirements including current trends and potential impact on the department, hospital, or system. Works collaboratively with the Nurse Manager Command Center to ensure the Utilization Plan is met and there are smooth handoffs with medical necessity reviews.

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at phoebehealth? Share your experience