Manager, Case Management Job Description

Manager, Case Management Job Description

171 votes for Manager, Case Management
Manager, case management provides vision and direction for case management by establishing a defined criteria set for moving patients along the acute care continuum incorporating the disciplines of social work, discharge planning and resource utilization.

Manager, Case Management Duties & Responsibilities

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

Sample responsibilities for this position include:

Providing ongoing assessment in case management of complex patients to ensure an accurate evaluation of patient needs, appropriate level of care, proper resource utilization, quality of care and risk management
Monitoring and evaluating the unit based case managers plan of care and concurrent reviews on an ongoing basis and revises goals as needed
Performing ongoing case management chart audits and implementing performance improvement plans, when necessary
Perform duties to conduct and manage the day to day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions
Collaborates the discharge planning activities for complex patients with the care team in order to ensure a timely discharge and to provide appropriate linkage with post-acute care providers
Communicates with the healthcare team regarding the discharge planning status of all patients referred
Appropriately documents in appropriate system, those patients identified as high risk for complex case management and enters all interventions
Identifies and refers potential quality concerns to the Inpatient Complex Case Management Planning Committee who would then refer to the Executive Leadership Committee
Delivery of cost-effective, appropriate healthcare services for members with complex and chronic care needs
Evaluation of over and under utilization of services

Manager, Case Management Qualifications

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

Licensing or Certifications for Manager, Case Management

List any licenses or certifications required by the position: BLS, CM, HCA, BCLS, CCM, AHA, CPR, PRI, UM, SMFE

Education for Manager, Case Management

Typically a job would require a certain level of education.

Employers hiring for the manager, case management job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Nursing, Education, Management, Medical, Performance, Pediatrics, Graduate, Social Work, Health, School of Nursing

Skills for Manager, Case Management

Desired skills for manager, case management include:

Interqual criteria
Case management
Utilization management
Utilization management and clinical nursing
Coding and DRG assignment process
Discharge planning
Managed care
Home health continuum

Desired experience for manager, case management includes:

Guiding and facilitating staff to obtain realistic treatment goals and reduce inappropriate utilization
Involvement in the hiring process of qualified staff
Ongoing management and development of staff performance
Nursing License
Bachelor’s degree in a related discipline and 2-5 years of experience in a sales or customer service role OR Master’s degree and 1-3 years of experience in sales or customer service role
Assisting in developing strategic plan by partnering with Assistant Director and Fund management to identify opportunities that have direct impact on clinical and financial outcomes

Manager, Case Management Examples


Manager, Case Management Job Description

Job Description Example
Our growing company is looking for a manager, 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 manager, case management
  • Oversight of departmental coordination of patient care within the continuum of care among the interdisciplinary team
  • Establishing appropriate staffing levels, work assignments, performance criteria, and appraisals and progressive discipline, if necessary
  • Oversight of RAC audits, insurance denials, avoidable delays in conjunction with or in the absence of the Department Director
  • Assuring unit based compliance with utilization requirements relative to all payor types and contract requirements
  • Maintaining ongoing communication regarding complex patient care with physicians, referral sources, caregivers, patients, to facilitate coordinate and transition care
  • Acting a central liaison with the Hospitalists physician group to ensure patient throughput and hospital metrics are met
  • Acting as an advocate for an individual’s health care needs the hospital’s business requirements
  • Reviewing / auditing patient satisfaction reports to identify trends and implement performance improvement initiatives
  • Reviewing / auditing and maintaining communication system with payors to determine benefit eligibility
  • On the basis of preliminary risk screening and referrals the clinician will assesses patient and family’s biopsychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope
Qualifications for manager, case management
  • Qualified candidates must be willing to work from the Indianapolis campus
  • Previous management experience preferred (3+ years)
  • Pharmacovigilence experience preferred
  • Demonstrated ability to develop and lead a team to deliver results
  • Demonstrated ability to communicate effectively (verbal and written), and to motivate and inspire others
  • Demonstrated ability to work independently and as a team member to manage complex initiatives across functions

Manager, Case Management Job Description

Job Description Example
Our company is looking for a manager, case 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 manager, case management
  • Completes monthly Corporate CM scorecard report
  • Ensure that case managers work to empower patients and family members to be active participants in their care and assist them in navigating the healthcare system
  • Conduct case reviews for progress, quality and accuracy
  • Leads the development of a plan of care with the multi-disciplinary healthcare team, patient, family and/or caregiver
  • Strong collaboration with Care Management staff for early notification of complex patients
  • Flagging patients using daily reports generated to assist with the identification of at risk patients
  • Aligns with families exhibiting complex family dynamics that impact directly on patient care and discharge
  • Provide education and consultation regarding resources, collaborate to develop a discharge plan and facilitate and monitor its implementation
  • Assist patient/family adjust to and cope with the illnesses, diagnosis, treatment options and prognosis
  • Through advanced practice skills mobilizes resources to reduce risk for our most vulnerable patients
Qualifications for manager, case management
  • Solid clinical skill in the practice setting
  • Bachelor's degree in healthcare or science related field
  • Full-time employment required
  • Experience in Global Patient Safety or related activities
  • Demonstrated ability to implement, interpret, and apply global regulations
  • Prior clinical experience nursing, pharmacy

Manager, Case Management Job Description

Job Description Example
Our growing company is looking to fill the role of manager, case 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 manager, case management
  • Works closely with community mental health, group homes, area agencies, community nursing homes, home health agencies, and air ambulance providers to ensure safe handoff and improve patient satisfaction
  • Identifies reports and resolves actual and potential delays in service and inappropriate use of resources
  • Coordinates referrals to the next level of care , SNF, LTAC, HHC, Hospice, Group Homes, Assisted Living and Air Flight Travel – Air Ambulance
  • Provide supervision of LLMSW’s with less than 4,000 hours of hospital experience, ensuring requirements mandated by the State of Michigan
  • Master's degree in Social Work from a school accredited by the Council of Social Work Education is required
  • Licensed to practice as an LMSW in the State of Michigan
  • The ability to work independently and be self-directed in a variety of stressful and demanding situations is essential
  • The ideal candidate will have significant medical social work experience, strong assessment skills, the ability to establish therapeutic relationships quickly, and to relate well to a diverse population
  • Clinical practice concentration and field practicum or recent work experience in a hospital preferred
  • More than 3 years of social work experience, preferred
Qualifications for manager, case management
  • Project management expertise with proven ability to oversee and manage multiple tasks/processes simultaneously
  • Current Colorado Registered Nurse License or LCSW required
  • BLS pref
  • RN, MSW or Master's Degree in a relevant clinical behavioral sciences field (social work, counseling, psychology, ) from an accredited university
  • Current Missouri R.N
  • One year experience working in a mental health setting

Manager, Case Management Job Description

Job Description Example
Our innovative and growing company is hiring for a manager, case management. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for manager, case management
  • Possess interpersonal communication negotiation skills in interactions with patient, families, Physicians and health care team colleagues
  • Maintain a current working knowledge of services available in the local community, particularly services available to patient with limited or non-existent payment resources
  • Be open to new learning experiences, flexible, open minded and adaptable to change
  • Work Services employees at assigned site
  • Facilitates processes to refine physician' s understanding of payer needs and alternate patient care options
  • Responsible for establishing, implementing and monitoring best practice and established clinical standards to assure the quality of patient care and the financial integrity of the organization
  • Be in a leadership position and provides ongoing vision and direction for the responsible programs
  • Be responsible for evaluation of programs and activities
  • Ensure the development and maintenance of policies and procedures and maintains program compliance required by regulatory and accrediting bodies
  • You are responsible for process improvement, quality assurance, and adherence to appropriate medical policy, care management best practices, relevant clinical standards, and member contract
Qualifications for manager, case management
  • University degree in a health related field such Kinesiology, Nursing, Psychology, Physiotherapy, Chiropractic, Rehabilitation or Occupational Health, or other regulated health care disciplines
  • 1-3 years experience as product owner in a contact center agent application with understanding of the user experience
  • 1-3 years experience as an Operations Product Owner in an Agile development process
  • Strong communication on medical management, operational, and business related issues Minimum of five (5) years’ management experience leading and managing teams required
  • Current FL licensure as an RN required
  • Experience in a customer service environment preferred

Manager, Case Management Job Description

Job Description Example
Our innovative and growing company is looking for a manager, case management. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for manager, case management
  • Participate with medical case manager and multidisciplinary treatment team to individualize each patient’s treatment needs in order to achieve defined goals for improved patient outcomes
  • Collaborate with medical case manager, physicians, and multidisciplinary team to develop and evaluate clinical pathways-standing orders
  • Serving as a subject matter expert for Case Management
  • Ensuring state and federal compliance with Utilization and Discharge Planning
  • You would hire, train, coach, counsel and evaluate performance of direct reports
  • Patient engagement and retention in specific Disease Management
  • Programs - Diabetes, Hypertension, CAD, Heart Failure, Asthma , COPD and Depression as a comorbidity
  • Utilizes established standards of care to identify and address members’ gaps in care
  • Utilizing motivational interviewing techniques for assisting members to move through the stages of behavioral change
  • Working with members to set and achieve SMART goals
Qualifications for manager, case management
  • 2 years’ experience in Case Management required
  • Formal education or training in supervision, management, or leadership
  • 7 years' of any combination of clinical and case management experience
  • Excellent interpersonal/consensus building skills the ability to work with a variety of internal and external colleagues from all levels of an organization
  • Coaching individuals to make lifestyle changes to reduce risk of disease processes
  • Exercise clinically sound judgment using relevant information, expertise, and decision support tools when interacting with members

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