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RN Case Manager - Utilization Management

Trinity Health • Full-time • Silver Spring, Maryland, USA • 1w ago

Employment Type:

Full time

Shift:

Day Shift

Description:

Position Purpose:

As a Case Manager in Utilization Management, you will be the key to ensuring patients receive appropriate, high-quality care. You’ll assess medical necessity, collaborate with healthcare teams and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization and maintaining the highest standards of care, you will contribute to a more efficient and patient-focused healthcare experience.

What You Will Do:

Evaluate and determine clinical appropriateness of inpatient admissions and observation status in compliance with payer requirements, clinical guidelines, and organizational protocols. Communicate findings with physicians to ensure alignment with medical necessity standards.
Work closely with physicians, nurses, and the admissions team to coordinate care and address clinical documentation needs for accurate case review and status determination.
Oversee the continuity of care by developing comprehensive care plans, ensuring seamless transitions between levels of care, and optimizing discharge planning to prevent re-hospitalizations.
Monitor and manage the utilization of clinical resources to ensure efficiency and cost-effectiveness while maintaining high-quality patient outcomes.
Provide guidance to clinical teams on proper documentation practices to support reimbursement and compliance with regulatory requirements.
Educate patients and families on care options, disease management, and anticipated outcomes, serving as a resource for navigating post-acute care services.

Minimum Qualifications:

RN licensed by the State of Maryland or Compact State license.
2-4 years of hospital case management experience preferred.
ASN required, BSN preferred
CCM certification preferred

Position Highlights:

Meaningful Impact: Ensure patients receive the right care at the right time by assessing medical necessity and streamlining care plans.
Interdisciplinary Collaboration: Work closely with physicians, nurses, and payers to align care delivery with clinical guidelines and regulatory standards.
Efficiency-Focused Role: Help optimize resource utilization and reduce unnecessary costs while maintaining high-quality patient care.
Remote Opportunity – Must live local to the D.C. Metropolitan area for on-site training and meetings.

Benefits:

Comprehensive benefit packages available, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from first day of employment.
Work/Life balance with flexible schedules.
Free onsite parking.
Our mission and core values are what drives each member of Holy Cross Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.

Pay rate: $40.99 - $61.49

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties — Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.

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