Case Management Team Lead

Under the general supervision of the Department Manager and in accordance with established policies, procedures, and professional guidelines, the Case Management Team Lead provides clinical leadership and operational support to the Case Management Department. This role is accountable for coordinating daily departmental activities, including staffing, scheduling, and workflow, to ensure safe, efficient, and compliant care coordination services. The Team Lead provides hands‑on mentorship, side‑by‑side support, and skill development for team members while promoting collaboration across departmental disciplines and interdisciplinary partners. The role identifies strengths, trends, and opportunities in clinical practice, escalates process improvement opportunities to leadership, and applies strong problem‑solving skills to support real‑time intervention. All duties are performed in alignment with Tampa General Hospital's mission, vision, values, and service excellence standards.

What you will do

• Oversees daily staffing, scheduling, and workflow to ensure appropriate coverage and continuity of utilization and case management services.
• Delivers side‑by‑side support, mentorship, and skill development to team members to promote clinical excellence, consistency, and adherence to utilization and care coordination standards.
• Ensures team members perform duties in accordance with professional standards, hospital policies, payer requirements, and regulatory guidelines.
• Guides staff in interpreting medical necessity criteria, evaluating appropriateness of services, and obtaining timely authorizations from managed and commercial payers.
• Serves as an escalation resource for complex clinical, authorization, discharge, or payer‑related issues and supports appropriate resolution prior to leadership involvement.
• Identifies trends, strengths, and improvement opportunities in clinical practice and workflow and escalates themes to departmental leadership.
• Applies critical thinking and problem‑solving skills to address workflow challenges, clinical barriers, and payer issues in real time.
• Promotes collaboration among physicians, nursing, social work, finance, and ancillary departments to support safe, timely patient care transitions.
• Arranges staff coverage as needed and provides direct coverage when necessary to meet patient care demands.
• Supports onboarding, orientation, and ongoing education of new employees, students, and assigned personnel.
• Demonstrates professionalism, accountability, teamwork, and customer service while consistently applying Tampa General Hospital service excellence standards of AKTiVe principles.

Education Qualifications

• Nursing
• Nursing

Licenses and Certifications

• Nursing

Experience Qualifications

• BS Nursing required or Associates degree in Nursing with a nursing certification.
• Experience: Three (3) years clinical experience with one (1) year of experience in Utilization Management, Case Management or two years in Emergency Management.
• Ability to read, write and speak English clearly and distinctly. Knowledge of Microsoft Office including Word, Excel, and PowerPoint required with knowledge of Microsoft Access, Project, Publisher, and MS Vizio, Microsoft Team Presenting platform, and audio/visual hardware.

Skills and Abilities

• Comprehensive knowledge of case management and utilization management, including care progression, discharge planning, authorization processes, and medical necessity management across Medicare, Medicaid, managed care, and commercial payer types.
• In‑depth experience applying InterQual or similar nationally recognized medical necessity criteria to evaluate appropriateness of admissions, continued stays, services, and level‑of‑care determinations.
• Ability to apply advanced clinical expertise and utilization management principles to evaluate appropriateness of services, resolve barriers to care, and support desired patient, quality, and organizational outcomes.
• Knowledge of federal, state, local, and payer regulatory requirements related to utilization review, reimbursement, discharge planning, care coordination, and compliance standards.
• Ability to mentor, coach, and support team members through side‑by‑side guidance, skill development, and performance feedback, promoting consistency in clinical practice and regulatory compliance.
• Ability to coordinate daily staffing, scheduling, and workflow; manage competing priorities; monitor workload distribution; and maintain departmental efficiency across UM and/or CM functions.
• Strong communication skills with the ability to collaborate effectively with physicians, interdisciplinary teams, patients, families, payers, and leadership to support medical necessity decisions, care coordination, denial resolution, and teamwork.
• Proficiency in Microsoft applications, including Outlook, Teams, Word, and Excel, to support communication, scheduling, documentation, reporting, data tracking, and operational coordination in a remote or hybrid work environment.
• Ability to utilize electronic medical records, utilization management systems, and reporting tools to support clinical decision‑making, workflow oversight, and accurate, timely documentation.
• Actively seeks opportunities to serve as the Case Management representative in hospital initiatives and cross‑departmental meetings.