Utilization Care Manager Jobs in Virginia (NOW HIRING)

Summary:
The Care Manager is a member of the Care Management team responsible for coordinating patient care across the continuum during assigned shifts. This role integrates clinical expertise with knowledge of post-acute care needs and community resources to support safe, timely, and cost-effective transitions of care.
The Care Manager performs core care management functions, including discharge planning, quality management, and resource utilization, while collaborating with the multidisciplinary team to achieve optimal patient outcomes.
This position is scheduled on an as-needed basis to support staffing and patient care demands, with no guarantee of hours. Assignments are based on areas of highest organizational and departmental need. While working, the Care Manager is expected to perform the essential functions of the role; however, this position does not carry ongoing responsibilities outside of scheduled shifts such as routine meeting attendance, committee participation, mentoring, or precepting. The incumbent is responsible for maintaining required competencies, licensure, and completion of mandatory education.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed; other tasks may be assigned.
• Demonstrates required clinical knowledge and psychomotor skills to perform job duties effectively
• Interprets and applies clinical data to prioritize patient care needs and determine appropriate actions
• Communicates and collaborates effectively with patients, families, and interdisciplinary team members
• Manages time effectively and independently prioritizes workload to meet deadlines and shift expectations
• Assesses, plans, implements, and evaluates care management strategies to support appropriate resource utilization and length of stay management
• Develops, implements, and evaluates individualized discharge plans for all assigned patients
• Completes thorough patient assessments including medical, functional, psychosocial, legal, financial, and safety needs
• Coordinates with physicians, nurses, social workers, and care team members to support safe and effective discharge planning
• Identifies and addresses social determinants of health and connects patients with appropriate community and support resources
• Leads discharge planning efforts, resolves barriers, and ensures timely and safe patient transitions
• Monitors length of stay, identifies delays or avoidable days, and escalates concerns appropriately
• Communicates effectively with providers, insurers, and stakeholders regarding utilization, discharge barriers, and authorization processes
• Facilitates peer-to-peer reviews and communicates insurance determinations or service denials as needed
• Ensures compliance with CMSA standards, organizational policies, licensure, certifications, and mandatory training requirements
• Performs PRN care management duties, floats to high-need units as assigned, and maintains proficiency within 90 days of hire or role transition
Supervisory Responsibilities
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education:
Bachelor of Science in Nursing (BSN), Associate Degree in Nursing with three (3) years of clinical experience, or a Bachelor's degree in Social Work required.
Experience: Minimum one (1) year of clinical experience required in an acute care setting.
Acute care case management, discharge planning, or care coordination highly preferred.
Must be self-directed and possess critical thinking and excellent organizational skills.
Certificates, Licenses, Registrations:
RN Licensure required unless you hold a degree in Social Work.
Obtain CPR certification within 6 months and maintain CPR certification by following hospital policy for renewals reference the RQI policy.
Physical Demands & Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.