Case Manager Jobs

The RN Care Manager practices with minimum supervision from another licensed professional and performs case management functions in accordance with Case Management Society of America Standards, including assessment, facilitating, planning, advocating, monitoring, evaluation, and outcomes. In collaboration with healthcare professionals, the position applies these components to coordination and service delivery, physical and psychological factors, benefit systems, cost-benefit analysis, case management concepts, and community resources. The case manager facilitates communication and coordination among the healthcare team and involves patients and families in decision-making to reduce fragmentation of care. The role helps improve care quality and reduce service costs on a case-by-case basis, while considering financial factors such as payer prior-approval requirements, alternative care options, medical-service cost containment, healthcare-plan appropriateness, home health and hospice resources, delivery systems, DRGs, case mix index, managed care, and capitation. The position collaborates with the Utilization Review Team on non-elective emergency inpatient admissions and outpatient observation stays; monitors observation stays at 23 hours for possible inpatient admission or discharge planning; and ensures patients are screened using InterQual/Milliman or other appropriate criteria. The case manager assists physicians in identifying alternatives when criteria are not met and works with the Physician Advisor on cases that do not meet admission or continued-stay criteria. The role also provides discharge planning referrals, collaborates to ensure timely services, identifies performance-improvement opportunities, assists with data collection, and supports the development and implementation of patient-care programs such as clinical pathways, population-specific initiatives, and disease-management programs. The expected average caseload is 20–25 patients per day.