Employment Type:

Full time

Shift:

Day Shift

Description:

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 high‑quality, cost‑effective, patient‑centered 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 evidence‑based nursing practice, patient safety, and interdisciplinary collaboration

• Oversee utilization management processes, level‑of‑care 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 system‑wide committees and strategic initiatives

 

Required Qualifications

• Active Registered Nurse (RN) license in Pennsylvania

• BSN required; MSN or Master’s 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 change‑leadership skills

 

Preferred Qualifications

• Master’s degree (MSN or related healthcare field)

• Experience in utilization management, denial management, and payer relations

• Prior leadership experience in a large health system or multi‑department environment

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

About Us: St. Mary Medical Center is a beautiful 53-acre state-of-the-art facility comprised of more than 700 physicians, nearly 3,000 colleagues, and 1,100 volunteers committed to providing quality care delivered with compassion and respect.  St. Mary attracts top doctors, introduces cutting-edge technologies and implements advanced procedures to meet the healthcare needs of the people it serves, including the nearly 630,000 residents of 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.