Nurse Manager – Care Coordination & Utilization Management

About This Role

This Nurse Manager will provide strategic and operational leadership for care coordination, case management, and utilization management services. The role focuses on ensuring high-quality, cost-effective, patient-centered care and optimizing patient throughput and regulatory compliance. They will partner with physicians, hospital leadership, and system stakeholders to achieve these goals.

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
• Support effective use of EPIC (TogetherCare) and reporting tools

Requirements

• Active Registered Nurse (RN) license in Connecticut
• BSN degree
• 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

Qualifications

• BSN required; MSN or Master’s in related field preferred
• Minimum 5 years of healthcare experience, including leadership or management

Nice to Have

• 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

Skills

* Required skills