CARE MANAGER JOB DESCRIPTION

A Care Manager is the professional who holds a patient's plan together when medical, behavioral, and social needs pull in different directions. This role owns the full coordination continuum from initial assessment through discharge or community transition, operating within clinical teams that serve high-risk and medically complex populations. Nationally recognized credentials such as the Certified Case Manager (CCM) and compliance with Medicare and Medicaid eligibility regulations define the professional baseline for this work. Few roles demand the same blend of clinical judgment and community resource knowledge.

As the Care Manager, you conduct comprehensive psychosocial and medical assessments to develop individualized care plans that keep high-risk patients connected to the right level of care across acute, community, and home settings. You work within a multidisciplinary team spanning physicians, behavioral health clinicians, and discharge planning staff, carrying direct accountability for plan implementation, documentation compliance, and outcome tracking.

Career Impact: Earning a Certified Case Manager (CCM) credential while managing complex, multi-system cases positions you among a recognized specialist tier within healthcare - distinct from generalist clinical roles and increasingly sought across managed care, health systems, and accountable care organizations.

Business Impact: The patients you serve carry the highest utilization risk in any health system; your coordination work directly reduces preventable readmissions and emergency department overuse, producing measurable cost and quality outcomes for both payers and care teams.

Growth Opportunity: Case managers who build expertise in both inpatient discharge planning and community-based care gain the dual-track experience that leads to senior care management, utilization review leadership, or population health program roles.

• Conduct comprehensive psychosocial, medical, and functional assessments to identify high-risk members and establish individualized care plans aligned to realistic, measurable goals.
• Coordinate care transitions across acute hospital, skilled nursing, home health, and community settings to ensure continuity and prevent avoidable readmissions.
• Monitor ongoing client status through home visits, telephonic follow-up, and facility visits, updating care plans in response to clinical changes or treatment complications.
• Partner with physicians, behavioral health clinicians, and community service providers to implement multidisciplinary interventions for patients with complex or multi-system needs.
• Document all assessment findings, interventions, care plan modifications, and clinical outcomes in the electronic medical record within required timeframes.
• Advocate for patients and families regarding benefit coverage, community resource access, and care options, including appeal rights when coverage determinations are disputed.
• Support quality assurance and utilization management activities by participating in case conferences, productivity reporting, and continuous improvement initiatives.

• Bachelor's degree in Nursing, Social Work, Psychology, or a related behavioral health field, or equivalent work experience.
• 3 or more years of experience in clinical case management, community health, or managed care, with demonstrated exposure to high-risk or medically complex populations.
• Working knowledge of Medicare and Medicaid eligibility requirements covering hospital, home health, nursing facility, and hospice levels of care.
• Demonstrated ability to conduct psychosocial and functional assessments and translate findings into actionable, individualized care plans.
• Strong written and verbal communication skills with the ability to document clinical activity clearly and within required timeframes.
• Ability to collaborate effectively within multidisciplinary teams including physicians, nurses, social workers, and community agency staff.
• Valid driver's license and reliable transportation for home and facility visits as required by the role.

• Certified Case Manager (CCM) or Accredited Case Manager (ACM) credential, or eligibility and active pursuit of certification within the first year.
• Qualified Mental Health Professional (QMHP-CS) certification or equivalent state behavioral health credential supporting direct clinical service delivery.
• Prior experience in inpatient discharge planning, home health, or utilization management within an acute care or managed care setting.
• Bilingual proficiency in English and Spanish or another language reflecting the served patient population.

• Care plan completion rate within required documentation windows, reflecting timely assessment and coordination activity.
• Preventable readmission rate for managed caseload, measuring how effectively transitions to lower levels of care are supported.
• Percentage of high-risk members reached within target contact timeframes after referral or discharge, tracking proactive outreach.
• Authorization accuracy rate for care coordination requests submitted to medical directors or payer sources.
• Caseload documentation compliance rate against electronic medical record standards, audited by quality assurance review.
• Typical tools: Electronic medical records (commonly Epic or Cerner); case management platforms (commonly Interqual or Milliman).

• Base Salary Range: $55,000 to $78,000 annually, depending on seniority and setting
• Bonus: Annual performance bonus of 3% to 7%, tied to quality and utilization metrics
• Equity: Not typically offered at this level in healthcare settings
• Health Benefits: Medical, dental, and vision coverage; employer contributes majority of premiums
• PTO: 15 to 22 days annually, plus federal holidays and sick leave
• Common Perks: Continuing education reimbursement, CCM exam fee coverage, mileage reimbursement for field visits

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Candidates for this position must be authorized to work in the United States. Employment is contingent upon the successful completion of a background check and, where applicable, a drug screening consistent with healthcare industry standards. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations are available to individuals with disabilities throughout the application and employment process upon request.

The Care Manager delivers comprehensive case management services to a medically diverse student population within a university health service, connecting high-risk and complex students with appropriate clinical and community resources. Reporting to the Student Health Service leadership and collaborating with PCPs and mental health clinicians, this role directly supports student academic success and sustained well-being.

Key Responsibilities

• Conduct assessment interviews to evaluate student needs and connect them with appropriate resources within the health service and community.
• Work with treatment providers including PCPs and mental health clinicians to encourage continuity of care.
• Create individual care coordination plans for high-risk and medically complex students and ensure linkage with appropriate care.
• Track and support students who are hospitalized or returning to campus after inpatient discharge and secure appropriate follow-up care.
• Provide psychoeducation and reinforce self-management goals and skills with students.
• Research and maintain an updated referral list relevant to a variety of health insurance plans.
• Participate in Quality Improvement activities and departmental and inter-departmental staff meetings.
• Participate in outreach efforts to educate students and campus partners about available health services.

Required Qualifications

• Bachelor's level nursing degree or equivalent in education and experience.
• Master's level mental health certification may substitute in part for experience.
• Minimum 3 years of experience, with prior experience in a university health service or comparable healthcare system preferred.
• Demonstrated excellence in multicultural competency.
• Excellent interpersonal and communication skills.
• Computer literacy required, including word processing and familiarity with electronic scheduling systems or electronic medical records.

Embedded within a multidisciplinary eldercare organization serving seniors across day care, nursing home, and home personal care settings, the Care Manager leads the full continuum of client case management from initial referral through outcome evaluation. Working closely with community agencies, specialists, and internal support staff, this role ensures vulnerable seniors receive coordinated, well-documented services that protect their health and independence.

Core Functions

• Manage case referrals and conduct assessment, planning, and intervention for cases in consultation with the ED.
• Engage clients, build rapport, perform needs assessments, and advocate for clients' needs.
• Coordinate services with community resources on the client's behalf and prepare case notes.
• Work with CAN1 carers to provide monitoring to clients and participate in case conferences.
• Monitor delivery of coordinated services and document and evaluate case outcomes.
• Develop and review appropriate intervention strategies in consultation with the ED.
• Provide supervision, guidance, and advice to support staff and volunteers, including CAN1 carers.
• Network with other agencies and specialists to provide multidisciplinary assessments and monitoring of clients.

Qualifications & Experience

• Bachelor's degree preferably in Social Work, Psychology, Sociology, Gerontology, or Counselling.
• Minimum 3 years of experience in community healthcare settings.
• Good knowledge of geriatrics and community services.
• Proficiency in MS Office applications.
• Good record-keeping abilities and attention to detail, with 1 to 2 years of administration experience preferred.
• Good communication skills in oral and written form.
• Good judgement, decision-making, and problem-solving skills, with a meticulous and independent working style.
• Ability to speak English, Mandarin, and Malay is an advantage.

Reporting to a clinical supervisor, the Care Manager shapes individualized, trauma-informed services for adults with multi-system involvement, including Criminal Justice, Child and Adult Welfare, Veterans, and Homelessness, delivering direct clinical care for 60% of hours worked across field and clinic-based settings. Partnering with a multidisciplinary team, this role advances person-centered recovery outcomes while maintaining full compliance with documentation, credentialing, and quality assurance standards.

Primary Duties

• Provide direct individualized clinical services for 60% of hours worked, including assessment, recovery planning, psychosocial rehab, skills training, medication support, case coordination, psychoeducation, crisis services, and discharge planning.
• Complete all required documentation on time and to standard.
• Participate in individual and group supervision and assigned meetings and trainings.
• Comply with and participate in Quality Assurance and Quality Improvement processes.
• Coordinate coverage for planned absences in advance with supervisor.
• Adhere to established employee handbook policies and procedures and maintain required credentials and mandatory training requirements.

Skills & Qualifications

• Bachelor's degree from an accredited university in a Behavioral Health field.
• Must complete the Qualified Mental Health Professional Community Services (QMHP-CS) credential within 6 weeks of hire.
• Minimum 1 year of experience providing similar clinical services.
• Prior knowledge of trauma-informed practices preferred.
• Proficiency with standard Microsoft Office applications and system databases.
• Bilingual in English and Spanish preferred.
• Must meet physical requirements including lifting to 12 lbs., supporting up to 55 lbs., and frequent walking, standing, bending, and kneeling.
• Able to travel as needed.
• Must maintain a valid driver's license and automobile insurance coverage.

Sitting at the intersection of clinical case management and community-based care for aging adults with disabilities, the Care Manager conducts comprehensive psycho-social, physical, mental health, environmental, and spiritual assessments to develop and continuously refine individualized Community Living Plans. Operating across home, acute hospital, and skilled nursing facility settings and serving as liaison among clients, caregivers, physicians, and community service providers, this role directly enables functionally impaired adults to maintain independence and quality of life.

Duties

• Conduct comprehensive assessments and re-assessments of client psycho-social, physical, mental health, environmental, and spiritual needs to develop the Community Living Plan.
• Conduct ongoing client home, acute hospital, and skilled nursing facility visits to review and modify the Community Living Plan.
• Provide crisis intervention, advocacy, problem solving, and therapeutic intervention services to clients.
• Document and update progress notes of all case management activity within 24 to 48 hours.
• Evaluate client ability to remain safely at home and coordinate appropriate placement if needed.
• Act as liaison between the client, caregiver, physicians, and community service providers to update, arrange, and monitor care.
• Attend program leadership, research, continuing education, and Care Manager Development Program meetings as required.
• Participate in and promote Continuous Quality Improvement efforts and attend relevant in-service training.

Requirements

• Master's in Social Work (M.S.W.) degree.
• Minimum 2 years of experience resolving medical and psycho-social problems for functionally impaired adults, including 1 year working with behavioral health or substance abuse populations.
• Case management experience in a community health care delivery system.
• Proficient computer literacy skills.
• Exceptional communication, presentation, and problem-solving skills.
• Bilingual language skills preferred.
• Proven ability to prioritize multiple tasks.

A key member of a managed care team, the Care Manager owns the full case management cycle for high-risk members, from comprehensive telephonic health assessments and individualized care plan development through authorization, intervention, and outcome evaluation. Collaborating across PCPs, inpatient programs, discharge planning units, and multidisciplinary teams, this role ensures continuity of care and cost-effective outcomes for beneficiaries across medical, mental health, and social service needs.

Functions

• Review high-risk reports, including wound care and emergency room utilization, and perform comprehensive telephonic health assessments for members meeting case management criteria.
• Develop individualized care plans with realistic, measurable goals and implement actions to prevent adverse events.
• Analyze member information to identify trends and anticipate care or cost impact, considering alternatives to achieve cost-effective outcomes.
• Work closely with PCPs, inpatient programs, and discharge planning units to proactively identify at-risk members.
• Perform authorizations, initiate plan modifications, and communicate with physicians when significant adjustments are needed.
• Maintain electronic documentation of all interventions, care plan changes, and clinical quality outcomes.
• Conduct member home visits, provide individualized and group education, and manage incoming calls from providers and members professionally.
• Participate in multidisciplinary team meetings, round clinic discussions, and produce productivity reports.

Experience & Qualifications

• Bachelor's degree in Nursing or Psychology.
• Current professional license in applicable jurisdiction, with Case Management certification preferred.
• Minimum 3 years of experience in healthcare, case management, acute care, home health, or managed care settings.
• Knowledge of healthcare regulations, benefit structures, and the ability to interpret technical and governmental guidelines.
• Computer literate with the ability to perform statistical reports and write business correspondence and procedure manuals.
• Strong planning, organizational, problem-solving, and analytical skills, including basic statistical and mathematical reporting ability.
• Excellent interpersonal, communication, customer service, and time management skills.
• Fluent in English and Spanish.

Safe, accurate patient discharge across complex acute and emergency care settings depends on the Inpatient Care Manager, who independently assesses admission appropriateness, level of care status, and length of stay while developing and implementing safe discharge plans for patients with complex needs. Based within an acute hospital environment and serving as expert consultant and educator to physicians and the broader care team, this role ensures optimal utilization of healthcare resources and full regulatory compliance throughout every care transition.

Accountabilities

• Review admitted patients for appropriateness of admission, level of care status, and length of stay, and ensure authorization from non-Kaiser payer sources.
• Provide timely notification to Patient Billing Services verifying correct admit status and facilitate care for non-Kaiser patients approved by their payer source.
• Identify potential delays in inpatient care that may extend length of stay and communicate findings for departmental improvement.
• Complete thorough, timely, age-appropriate assessments reflecting psychosocial support systems, care needs, benefit array, and level of care determinations.
• Develop safe discharge plans in collaboration with patients, families, and health care teams to optimize available resources for each patient's needs.
• Document all referrals and handoffs between care settings and act as liaison to care facilities to resolve barriers to safe transfers.
• Provide education and leadership in discharge planning, including developing policies and procedures for patient transfers across care settings.
• Ensure regulatory and compliance standards are met and participate in quality, utilization management, and continuing education activities.

Technical Qualifications

• BSN or bachelor's degree in a health-care related field, or 4 years of hospital case management experience.
• Current RN license in the state of assignment and Basic Life Support (BLS) certification required.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification preferred, MSN a plus.
• Acute hospital experience, with at least 2 years in Medical/Surgical or Critical Care Nursing.
• Recent experience in inpatient discharge planning, community health, home health, or utilization management.
• Knowledge of Medicare and Medicaid regulations covering hospital, nursing facility, home health, and hospice eligibility requirements.
• Strong clinical judgment and physical and psychosocial assessment skills.
• Thorough clinical documentation ability.
• Excellent problem-solving, verbal and written communication, organizational, and time management skills.