Care Management Job Description

Care Management Job Description

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Care management provides behavioral healthcare for patients in a wide range of issues, both medical and behavioral health, across the lifespan.

Care Management Duties & Responsibilities

To write an effective care management job description, begin by listing detailed duties, responsibilities and expectations. We have included care management job description templates that you can modify and use.

Sample responsibilities for this position include:

Serves as internal consultant and subject matter expert to the interdisciplinary team on matters related to care coordination, discharge planning, levels of care, utilization management, insurance benefits and community based resources
Ensures compliance regarding resource allocation, utilization management, discharge planning and interdisciplinary team processes in accordance with regulatory/accreditation agencies, including but not limited to DOH, TJC, CMS, IPRO, OMH
Develop, train and mentor Care Managers
Ensure timely submittal of all documentation and forms in accordance with company guidelines
Review referral information and all existing assessments prior to the coordination of the initial team meeting and assignment of youth to a Care Manager
Training and supervision of the care management nurses
Working with the Director of Clinical Operations to ensure that all functions of the care management department are being completed
Taking all clinical direction from the Senior Medical Director to develop appropriate Care Management Work Plans
Implementation of the Care Management Work Plan
Overseeing the education program

Care Management Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Care Management

List any licenses or certifications required by the position: CCM, ACM, BLS, MA, URAC, CPR, PMP, BC, RN, UPMC

Education for Care Management

Typically a job would require a certain level of education.

Employers hiring for the care management job most commonly would prefer for their future employee to have a relevant degree such as Master's and Bachelor's Degree in Nursing, Education, Management, Social Work, Health, Associates, Gerontology, Medical, Healthcare, Public Health

Skills for Care Management

Desired skills for care management include:

Healthcare delivery
Community
State and federal laws and resources
Medical terminology
Excel
Utilization management
Broad range of medical practice specialties
Word
Health insurance industry trends
Technology and contractual arrangements

Desired experience for care management includes:

Working with managed care plans to implement cost reduction programs
Working with Senior Medical Director and Director of Clinical Operations to create policies and procedures, nursing assessments and care plans
BSN from accredited nursing program
Supervisory experience in medical group or hospital setting
Experience with implementing or overseeing a care management program in either a medical group, managed care or hospital setting
Monitor need for HINN, HRR and Important Message from Medicare

Care Management Examples

1

Care Management Job Description

Job Description Example
Our innovative and growing company is hiring for a care management. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for care management
  • Develops and maintains relationships with post-acute-care services providers necessary to coordinate the appropriate utilization of hospital resources and meet the clinical needs of hospital patients
  • Plans, directs and supervises all aspects of Care Management
  • Collaborates with the medical staff on resource utilization issues, and compliance with payer and utilization-related private contracts, public programs contracts and applicable federal and state regulatory mandates
  • Analyzes and monitors quality, customer service, cost reimbursement and utilization trends that support organizational financial performance
  • Develops staff performance plans, provides regular performance feedback, manages direct reports and performs personnel actions in accordance with policy & procedure
  • Develop strong understanding of healthcare services and networks and answers a wide variety of related patient questions
  • Respond to patient and physician office referral requests that come through phone, fax, online
  • Ask probing questions to fully understand patient needs
  • Utilize patient search criteria (condition, geographic location, insurance, ) to select the best referral option
  • Introduce patients to service line staff and remains on the line as required for more detailed questions or referral needs
Qualifications for care management
  • Associate’s or Bachelor’s Degree in Business, or experience in Recruitment (preferably healthcare)
  • Minimum of 5 years of care coordination or discharge planning experience, preferably in a hospital setting
  • Must be a registered nurse (bs preferred) with an active license in state of employment
  • Must have a minimum of one year clinical experience in an acute care or other health care setting
  • Highly desirable is prior discharge planning and utilization experience
  • Requires the ability to walk to various locations throughout the Clinic and facilities
2

Care Management Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of care management. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for care management
  • Make appointments and/or coordinate with facilities/clinics to provide timely appointments
  • Educate referred patient about travel directions, parking information, dining and lodging near clinical services
  • Serve as the ongoing liaison for patients as required
  • Process referrals and intake forms for specific programs, and follow-up with patients or providers on missing information
  • Process pre-authorizations for specific programs and communicate with insurance companies
  • Educate patients on financial resources available
  • Follow up with patients who were to call a specialist to schedule their appointment but don't follow through
  • Assist patients with access to educational, emotional and financial resources
  • Provide links and education regarding web resources (institutes, services, providers, MyChart, videos, forms)
  • Perform the work required to provide an answer to patient or referring provider’s needs internally, so the customer only has to call us once (first call resolution)
Qualifications for care management
  • One year health care/recruiting experience
  • At least 3 years of experience as a healthcare consultant with PCMH - Patient Centered Medical Home expertise Case Management/resource management, care protocols, care gaps, and clinical workflow
  • Local travel of up to 10 - 25% may be possible
  • Experience with Dynamo CM application preferred
  • Register patients and the public for classes
  • Communicate effectively via phone, e-mail, chat, instant message
3

Care Management Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of care management. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for care management
  • Become knowledgeable of Patient Engagement Center processes and technology, including a phone system, health information system (Epic), and customer relationship management (CRM) system
  • Participate in department continuous quality improvement processes, and takes ownership for ongoing performance development
  • Maintain a sense of pride and ownership for the program and care of each patient
  • Reviews cases regularly with staff
  • Serves as a content expert to staff and internal departments and external partners
  • Refines and improves departmental processes/workflows/ policies and procedures to meet the evolving needs of patient populations, the healthcare team, and the healthcare system using employee and patient satisfaction financial, operational and outcomes data
  • Ensures that positive patient and financial outcomes are achieved through the appropriate screening, transitional planning, and placement of patients
  • Determines data necessary to drive operational processes and analyzes and interprets data to drive performance improvement efforts to optimize productivity and outcomes
  • Implement, enforce, and evaluate hospital, departmental, and interdepartmental policies and procedures, and participate in necessary revisions to promote evidence-based practice and to ensure regulatory compliance
  • Develops, implements, and monitors budgets and cost controls
Qualifications for care management
  • Experience with ancillary service authorizations
  • Bilingual (English and English or Spanish)
  • Knowledge and expertise in developing and using data management tools, software, and office machines
  • Excellent time management skills and the ability to work within strict time frames
  • Must be flexible, well organized, and able to prioritize appropriately with strong time management and follow-through skills
  • Ability to work independently the ability to establish and maintain cooperative and “team” oriented working relationships with others
4

Care Management Job Description

Job Description Example
Our company is growing rapidly and is looking for a care management. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for care management
  • Performs utilization management for inpatient admissions
  • Promotes a positive work environment by setting an atmosphere of open communication and feedback
  • Prepares staffing plans and schedules performance appraisals and approves hiring, and termination/discipline decisions in accordance with organizational policies
  • Provides for staff in-service education and promotes excellence via clinical rounds, case reviews, quality, and/or PI initiatives
  • Participates in or chairs appropriate councils, committees, activities, and special projects representing the department and/or hospital as assigned
  • Participates as a member of the multi-disciplinary team to accomplish DSRIP goals
  • Enhances professional growth and self-development and applies information from educational programs, workshops, review of literature and specialty and/or professional organizations to areas of responsibility
  • Demonstrates the ability to organize, plan and successfully effect change
  • Manage, hire and mentor, staff to meet corporate and departmental goals
  • Initiate and develop clinical programs that support the care management model and enhance health engagement through member education, employer support and provider collaboration
Qualifications for care management
  • Minimum of 3 years clinical setting experience required
  • Shares knowledge with real world examples, leveraging past clinical experience, and using various teaching styles to ensure understanding of audience
  • Demonstrates ability to recognize trends and gaps in implementations and process
  • Demonstrated ability to develop collaborative working relationships
  • Knowledgeable of value based reimbursement models
  • Demonstrated experience leading groups and presentation skills
5

Care Management Job Description

Job Description Example
Our company is growing rapidly and is hiring for a care management. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for care management
  • Coordinates management of patient through various community resource options
  • Site supervisor of Care and Utilization Management
  • Perform case management of chronic and catastrophic cases to effectively manage services, benefits, costs and quality following policies and procedures of the Utilization Management Program
  • Track and report case management activities, savings and outcomes as appropriate for the individual program and as required, supporting the Utilization Management Program
  • Participate in the development and monitoring of the department business plan, operating budget
  • Ensure the appropriate administration of member benefits
  • Educate staff on company priorities and expected departmental contributions
  • Acts as informed resource on policies and benefits
  • Recruitment, selection, orientation, performance measurement
  • Obtain timely pre and post authorizations from insurance companies for services and enter data into the electronic medical record
Qualifications for care management
  • The Director is responsible for the strategic planning, development, administration and operations of Care Management and Social Services for the hospital along with the transition of care for patients
  • Requires five (5) years’ clinical and administrative experience
  • Five (5) years’ in management of inpatient care preferred
  • Must have the ability to work effectively under pressure
  • Must be able to work with the Information Service department to maintain performance of computer hardware and software within the department
  • The ability to lead through influence and persuasion is required

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