Case Management Job Description
Case management
provides concurrent education regarding SI/IS criteria and managed care regulations to attending physicians, house staff and other hospital personnel on an on-going basis.
Case Management Duties & Responsibilities
To write an effective case management job description, begin by listing detailed duties, responsibilities and expectations. We have included case management job description templates that you can modify and use.
Sample responsibilities for this position include:
Monitor the delivery of case management services to patients at each location ensuring compliance with all aspects of case management care in accordance with Stony Brook and WTC HP policies and procedures
CCM (Certified Case Manager) or ACM (American Case Management Certification) or will obtain in the first year of employment
Monitoring case management and support staff activity to ensure that the case load is distributed appropriately, the services delivered are in keeping with World Trade Center Health Program Clinical Center of Excellence quality standards and that each site operates efficiently
Provide back up to case management staff as needed
Ensure processes are in place to standardize case management services at both locations
Assist with the creation and implementation of policies and procedures regarding case management
Manage case management operations in an independent manner with minimal day to day supervision/direction but work closely with the Clinical Administrative Manager and Deputy Director over concerns with meeting goals, operational obstacles, or compliance issues
Facilitate on-going communication between Case Management staff, patients, providers, and other involved entities
Compile and review multiple reports for tracking purposes to identify case management trends and assist in forecasting
Oversee and provide support, guidance and coaching to case management team and team leaders
Case Management Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Case Management
List any licenses or certifications required by the position: BLS, CM, CCM, HCA, PRI, ACM, CNA, CPA, HIPAA, UM
Education for Case Management
Typically a job would require a certain level of education.
Employers hiring for the case management job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Social Work, Management, Science, Health, Human Services, Graduate, Health Care, School of Nursing
Skills for Case Management
Desired skills for case management include:
Microsoft Office products
Medical terminology
Workers' compensation laws and regulations
Guidelines and national standards of practice
Managed care with emphasis on use of criteria
Case management
Regulations and contractual obligations and parameters of third-party reimbursement
Managed care
Medicare regulations
Utilization management
Desired experience for case management includes:
Manage specific diseases such as, Diabetes, Asthma, COPD, and Cardio Vascular Disease
Assist in patient treatment and rehabilitation
Provide optimal healthcare for patients
Experience in KYC and AML including knowledge and understanding of US AML/BSA laws and regulations AML trends and issues
Strong interpersonal skills and the ability to handle conflict and manage expectations
5 years of managerial experience within an acute hospital
Case Management Examples
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Case Management Job Description
Job Description Example
Our innovative and growing company is hiring for a case 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 case management
- Analyze physician utilization patterns, comparing to national and individual hospital standards
- Responds to patients and families with knowledge of age specific, infant, pediatric, adolescent, young adult, middle adult and older adult needs based on scope of service of unit/department where assigned
- Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated
- Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction
- Maintains client's privacy and confidentiality, promotes client safety and advocacy
- Enters new claims data into the claims management system accurately
- Ensures by confirmation that fax forms and filings required by regulatory agencies have been received
- Assist with arrangement of post-acute care services such as Home Health, Durable Medical Equipment, OP Dialysis, OP IV Infusion, and OP Wound Care
- Assist in arranging post-discharge services
- Conduct patient satisfaction follow up calls
Qualifications for case management
- Previous experience as a case manager
- Knowledge of healthcare financial, regulatory and payer issue setting
- Knowledge of state, local and federal programs
- Experience with Millimen/Interqual criteria
- PRI/Screen certification
- Work may include occasional publishing and/or pulling, lifting and carrying objects weighing up to 20 pounds such as files, documents and computer printouts
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Case Management Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of case management. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case management
- Daily oversight of utilization review activities to ensure compliance with Medicare and Medicaid contractual agreements with Managed Care contracts
- Maintains knowledge of current managed care contracts, federal statutes, regulations and procedures and applies them in performance of review activities
- Three years in Case Management and one year experience at a supervisory/manager level
- Greater than five years’ experience in Case Management with 3 years’ experience at a supervisory/manager level
- Minimum 2 years relevant Industry experience in AML/KYC
- Degree level qualification of Bachelor’s degree or equivalent
- Able to demonstrates thought leadership through mobilization of support or coalitions and positions champions to energize and sustain the desired change
- Proactive, demonstrate your own initiative and ability to assert oneself
- Ability to sell ideas and concepts to gain ‘buy in’ from stakeholders
- High flexibility and engagement, ability to work under pressure
Qualifications for case management
- Bachelor's degree from an accredited college or university in human services OR an AA degree and two years of caseload experience OR an AA degree and two years of employment counseling experience
- Bachelor's degree from an accredited college or university, preferably in a human services related field, or four (4) years of experience in employment services or human services
- Bilingual capabilities in Arabic or Farsi preferred
- Execute appropriate investigation techniques, and use good judgment and balanced consideration of all available facts and information to determine outcome
- Good investigation and problem solving skills and able to evaluate medium to complex situations using multiple sources of information
- Current State of Mississippi or Compact license as a Registered Nurse
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Case Management Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of case management. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for case management
- A mature and professional candidate who is self-motivated and enthusiastic
- Excellent communicator, articulate and well presented, must be able to communicate with all levels of seniority within the organization
- Provide guidance and support to staff members to ensure they are able to perform their work effectively and efficiently
- Develop, implement and maintain departmental policies and procedures in accordance with Joint Commission, Federal, State and Municipal requirements to ensure safe and effective services
- Communicate with physicians at regular intervals throughout hospitalization and develop an effective working relationship to assist the physicians to maintain appropriate cost and desired patient outcomes
- Participate in personnel functions including hiring, evaluations, disciplinary actions and terminations
- Complete expanded assessment of patient/family needs at time of admission and assess patient progress throughout expected hospital course
- Assist with coordination of certification process as needed
- Provide oversight to the cancer screening program
- Identify and supervise ongoing staff training to ensure proficiency and technical competence among employees
Qualifications for case management
- Certification in Clinical Resource Management (CCRM) is preferred
- Requires 3 years clinical RN generalist experience in an inpatient facility, hospital or health system
- Insurance/payor experience preferred
- 5 years health care experience, Supervisory/Management experience preferred
- A current and valid license as RN in the State of California
- Master's degree or above in Psychology, Social Work, Counseling or other area that require equivalent clinical coursework
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Case Management Job Description
Job Description Example
Our company is searching for experienced candidates for the position of case management. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case management
- Acts as liaison to Administration, Medical Staff, and outside agencies relative to UR, Case Management activities
- Recommends evaluation studies, clinical monitors, UR, Case Management topics for consideration
- Assists in the assessment of anticipated impact of external regulations and cost-containment efforts related to Utilization Review, Case Management
- Oversees Case Management activities
- Keeps current on literature standards and regulations pertaining to Case Management
- Working knowledge of Federal, State and regulatory requirements in quality assessment, case management, resource management, hospital systems, accreditation, and licensure
- Ensure standardized protocols and quality initiatives are adhered to so as to improve patient outcomes
- Ensure compliance with referral, certification and authorization policies, procedures and processes
- Participate in Clinician and Administrative meetings and other meetings as necessary
- Work closely with other management staff to ensure excellent integrative approaches to patient issues
Qualifications for case management
- Must possess knowledge, skills and abilities in the areas of family dynamics crisis interventions management and ability to work well under pressure and under short deadlines
- Must have skills in the supervision of non-licensed therapist
- Reviews data to identify principle member needs and works under the direction of the Case Manager to implement care plan
- Schedules member visits with team members as needed
- Coordinates required services in accordance with member benefit plan
- Processes member and provider correspondence
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Case Management Job Description
Job Description Example
Our innovative and growing company is looking for a case management. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case management
- Complete performance evaluations and disciplinary paperwork as needed
- Assure compliance with emergency management policies, procedures and processes
- Directs and supervises assigned staff throughout the state including performance evaluations, scheduling, orientation, and training
- Patient satisfaction scores meet organizational goals for HCAHPS
- Strives to provide excellence in service to hospital staff, patients and families
- Consistently assumes authority for department activity
- Serves as a clinical role model for staff
- Conducts regular scheduled and as needed staff meetings
- Prepares and administers performance evaluation for staff
- Works to have staff retention
Qualifications for case management
- 3-5 years of experience of handling adverse events
- Previous experience processing cases
- The ideal candidate will have a Master’s degree in Nursing or a healthcare related field required
- Three to five years of management experience, with demonstrated experience handling a variety of healthcare surveyors including, the joint commission and the Centers for Medicare and Medicaid Services (CMS)
- Experience in third party contracting, URAC standards, outcome analysis, project management and data systems required
- Bachelors degree in clinical area required