Clinical Manager - Care (Case) Management

Fusion HCR is Hiring!

Role: Clinical Manager - Care (Case) Management
Location: Las Vegas
Work Arrangement: Onsite
Employment Type: Permanent
Industry: Hospitals and Health Care

Lead care management in a hospital setting, helping coordinate patient care across the continuum while supporting effective clinical and financial outcomes.

Position Overview

Fusion HCR is seeking a Clinical Manager - Care (Case) Management to develop, implement, and maintain an outcome management system and ensure coordination of care across the continuum on a financial platform. This leader applies nursing and case management expertise to support care planning, utilization review, and appropriate patient care transitions. The role oversees assigned staff and works with patients and a broad range of healthcare personnel. Success requires an understanding of acute care criteria, authorizations, eligibility, reimbursement, and review processes, as well as the ability to communicate effectively in a clinical environment.

Key Responsibilities

- Develop, implement, and maintain a system for managing patient outcomes.
- Coordinate care across the continuum while considering financial and reimbursement requirements.
- [Suggestion: Guide case management activities related to eligibility, authorizations, admission assessment, concurrent and retrospective reviews, denials, and appeals.]
- [Suggestion: Support the review of patient records against acute care criteria and applicable clinical guidelines.]
- Oversee and support assigned staff, applying supervisory principles and practices.
- Promote patient care planning and coordination consistent with nursing processes, standards of care, patient rights, and age-specific practices.
- Interpret relevant rules, regulations, and policies, including those related to third-party reimbursement and nursing practice.
- Maintain effective working relationships and communicate with patients and colleagues from diverse backgrounds, including in stressful situations.

Required Qualifications

- Graduation from an accredited school of nursing.
- At least five years of clinical nursing experience, including at least two years in a supervisory or management role.
- Current license from the State of Nevada to practice as a Registered Nurse.
- Basic Life Support (BLS) certification accepted by the American Heart Association.
- Knowledge of care management principles, nursing processes, patient assessment, care planning, patient rights, infection control, and relevant safety practices.
- Ability to interpret regulations and analyze medical charts against acute care criteria.
- Strong communication and relationship-building skills, including the ability to work effectively with people from diverse backgrounds.
- Computer skills and experience using a variety of software applications.
- Preferred: Bachelor’s degree in nursing; extensive nursing, case management, and recent case management leadership experience; recent acute care experience; and CCM or ACM certification or membership in a relevant case management organization.

Why Join Us

- Contribute to coordinated patient care and outcome management in a hospital setting.
- Apply clinical nursing and case management expertise to complex care coordination and review processes.
- Work closely with staff and healthcare personnel across the care continuum.