Job Summary
The Manager of Case Management is a working manager responsible for the daily operations, supervision, and strategic direction of the hospital’s case management department while maintaining an active patient caseload. This dual-role leader ensures effective coordination of care, appropriate utilization of resources, and timely discharge planning for patients in the acute care setting. The Manager collaborates with physicians, nursing, ancillary services, and community partners to promote patient-centered care, regulatory compliance, and optimal outcomes.
Essential Duties and Responsibilities
Leadership & Management Responsibilities:
- Oversees daily case management operations, ensuring compliance with hospital policies, regulatory standards, and accreditation requirements (e.g., CMS, The Joint Commission).
- Supervises and mentors case management staff, including RNs, social workers, and support staff, fostering professional growth and accountability.
- Develops staff schedules, manages workloads, and assigns cases to ensure equitable distribution and appropriate coverage.
- Monitors key performance indicators (e.g., length of stay, readmission rates, discharge timeliness) and implements process improvements to meet or exceed benchmarks.
- Provides education and guidance on complex cases, payer requirements, and discharge planning best practices.
- Participates in budget planning, staffing models, and resource allocation for the department.
- Serves as a liaison with hospital leadership, payers, and external agencies regarding case management initiatives and patient care issues.
- Oversees and participates in utilization review activities to ensure the appropriateness of admission, continued stay, and discharge decisions.
- Works with physicians, nursing staff, and payers to resolve medical necessity or level of care issues.
- Provides education to case management team on payer requirements and utilization management best practices.
Clinical Responsibilities:
- Maintains an active caseload, performing assessments, developing care plans, and coordinating discharges for assigned patients.
- Conducts utilization reviews to ensure appropriate level of care, documentation, and reimbursement.
- Identifies and addresses barriers to discharge, collaborating with patients, families, and the interdisciplinary team.
- Educates patients and families on available resources, post-acute care options, and insurance coverage.
- Documents all case management activities in the medical record according to hospital standards.
Qualifications
Education:
- Bachelor of Science in Nursing (BSN) required; Master’s degree in Nursing, Social Work, Healthcare Administration, or related field preferred.
Licensure/Certification:
- Current RN license in the state of practice (or LMSW for social work-based managers).
- Case Management Certification (ACM, CCM) strongly preferred or required within 2 years of hire.
Experience:
- Minimum of 5 years of acute care clinical experience, with at least 2–3 years in case management or care coordination.
- Prior leadership or supervisory experience strongly preferred.
Skills/Abilities:
- Demonstrated leadership, team-building, and mentoring abilities.
- Strong knowledge of discharge planning, utilization review, payer requirements, and community resources.
- Excellent communication, negotiation, and conflict resolution skills.
- Proficiency in electronic medical records and Microsoft Office applications.
Performance Expectations
- Balances leadership duties with direct patient care responsibilities effectively.
- Demonstrates commitment to patient-centered care, quality, and safety.
- Meets departmental performance metrics and supports hospital-wide strategic initiatives.
- Maintains confidentiality, professionalism, and compliance with ethical standards in all activities.
Physical and Working Conditions
Work performed primarily in an acute care hospital environment with frequent patient, family, and staff interactions. Requires the ability to walk/stand for extended periods and occasionally lift up to 20 lbs.
Benefits:
- Comprehensive health, dental, and vision insurance
- Health Savings Account with an employer contribution
- Life Insurance
- PTO
- 401(k) retirement plan with a company match
- And more!
Equal Employment Opportunity (EEO) & Americans with Disabilities Act (ADA) Statement
Our hospital is committed to fostering an inclusive and diverse workplace. We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law. Additionally, we are dedicated to providing reasonable accommodations to qualified individuals with disabilities in the application and employment process. If you require assistance or an accommodation due to a disability, please contact Human Resources so that we may engage in an interactive process to determine an appropriate accommodation.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
