Title: Complex Case Manager 
Location: Dalton, GA
Duration: Full-time, Permanent

Shift/Schedule: 

• Saturday, Sunday, and Monday
• Three 12-hour shifts per week
• Typical hours: 7:00 AM – 7:00 PM
• Additional weekday shifts may be available based on departmental needs
• Weekend differential applies

Job Summary
The Complex Case Manager is responsible for coordinating complex patient care across the healthcare continuum within an acute-care hospital environment. This position works closely with physicians, nursing teams, patients, families, Utilization Management, and other members of the interdisciplinary care team to support safe, timely, and effective patient transitions.

The role is heavily focused on discharge planning, patient progression, and care coordination, with some utilization review and admission-related responsibilities as needed. The Complex Case Manager helps identify and remove barriers to discharge, coordinates appropriate post-acute services, and ensures patients transition to the appropriate level of care.

This position supports patients throughout the hospital and manages an average caseload of approximately 25 patients per day. Because the weekend Case Manager operates with a high level of independence, the ideal candidate will bring strong acute-care case management and discharge-planning experience.
Schedule

Key Responsibilities

• Manage an average caseload of approximately 25 patients per day across the hospital.
• Assess patients with complex medical, psychosocial, financial, and discharge-planning needs.
• Develop and coordinate individualized care and discharge plans in collaboration with physicians, nursing staff, patients, families, and the interdisciplinary care team.
• Facilitate safe and timely discharges while identifying and resolving barriers that could delay patient progression.
• Coordinate post-acute services including home health, durable medical equipment, rehabilitation, hospice, community resources, and other appropriate levels of care.
• Monitor patient progression throughout the hospital stay and ensure appropriate follow-through on established care plans.
• Serve as a patient and family advocate while facilitating communication between all members of the healthcare team.
• Support admission-related activities as needed, including payer notification and coordination of inpatient admissions.
• Collaborate with Utilization Management when medical necessity or level-of-care review is needed.
• Utilize InterQual criteria as appropriate for the utilization review portion of the role.
• Work with physicians and other clinical leaders when patients do not meet admission or continued-stay criteria and help identify alternative levels of care.
• Monitor observation and long-stay patients and assist the interdisciplinary team with resolving barriers and developing alternative plans.
• Support appropriate utilization of healthcare services while balancing patient needs, quality of care, and cost considerations.
• Maintain knowledge of Medicare, Medicaid, managed care, commercial insurance, prior authorization requirements, and healthcare reimbursement practices.
• Promote effective resource utilization, continuity of care, and safe transitions across the healthcare continuum.

Qualifications/Education

• Graduate of an accredited School of Nursing required.
• Bachelor of Science in Nursing (BSN) preferred.

Licensure & Certification

• Current Registered Nurse (RN) license in the State of Georgia required.
• Current BLS/CPR certification required.
• Case Management certification preferred.

Experience

• Minimum of 3–5 years of RN experience.
• At least 2 years of recent clinical nursing experience required.
• Strong acute-care case management and discharge-planning experience strongly preferred.
• Candidates should be comfortable independently managing complex discharge situations and following cases through successful resolution.
• Utilization Review experience is helpful but is not the primary focus of the position.
• Experience with Epic or a comparable electronic medical record system preferred.

Knowledge & Skills

• Strong knowledge of acute-care case management and discharge planning.
• Ability to independently manage complex patient situations and competing priorities.
• Strong clinical judgment and problem-solving skills.
• Understanding of utilization management, medical necessity, and payer requirements.
• Familiarity with Medicare, Medicaid, managed care, and commercial insurance.
• Excellent communication and collaboration skills with physicians, nurses, patients, families, and other healthcare professionals.
• Strong organizational and follow-through skills.
• Ability to identify barriers to discharge and develop practical solutions.
• Patient-centered mindset and strong commitment to advocacy and continuity of care.
• Collaborative attitude and ability to work effectively across multiple hospital departments.
• Comfortable working independently in a fast-paced acute-care environment.

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $64000.00/Yearly - $85000.00/Yearly.