CASE MANAGEMENT JOB DESCRIPTION

When case documentation lapses and clinical escalations go unresolved, patients fall through the gaps that managed care programs exist to close. The Case Management role holds the function that prevents that: owning a defined caseload of members from intake through closure, operating within URAC- and NCQA-governed standards that set measurable expectations for timeliness and clinical rigor. Accountability here is specific. This role answers to program leadership and is evaluated against documented case outcomes, audit results, and adherence to the HEARTH act or equivalent regulatory frameworks depending on the service setting.

As the Case Management professional, you will coordinate individualized care plans for members across clinical and community-based service lines, ensuring each case meets regulatory requirements and progresses toward measurable health or housing outcomes. You will report to a program supervisor or clinical director, working within a defined caseload structure that spans initial assessment, active coordination, and formal case closure.

Career Impact: Carrying a caseload governed by CCM standards and URAC compliance requirements positions a Case Management professional as a credentialed specialist, not a generalist, within the managed care labor market.

Business Impact: Each case this role closes correctly reduces avoidable readmissions, gaps in member eligibility coverage, and audit findings that cost programs their accreditation standing.

Growth Opportunity: Case Management professionals who demonstrate clinical leadership and performance improvement results move into supervisory titles such as Case Management Supervisor and Clinical Team Lead, with direct authority over staff and program design.

• Manage an assigned caseload of members from intake through case closure, ensuring all documentation meets URAC and NCQA standards.
• Conduct initial and ongoing assessments to identify member needs, risks, and appropriate levels of care.
• Coordinate care plans in collaboration with clinical staff, community agencies, and external stakeholders to support health and housing stability goals.
• Review case progress regularly and determine case closure readiness based on documented outcomes and program criteria.
• Audit case files and documentation for accuracy, completeness, and compliance with regulatory and contractual requirements.
• Respond to escalated member issues and clinical questions, channeling to appropriate staff or senior resources when needed.
• Monitor quality assurance standards and contribute to performance improvement plans based on call monitoring and case audit findings.
• Participate in staff meetings, supervision sessions, and training to apply updated clinical and regulatory knowledge to active caseloads.

• Bachelor's degree in Social Work, Human Services, Nursing, or a related health field, or equivalent work experience.
• Two or more years of case management experience in a managed care, clinical, or community health setting, with direct caseload responsibility.
• Knowledge of URAC, NCQA, or HEARTH act compliance standards as they apply to case management documentation and service delivery.
• Demonstrated ability to conduct member assessments, develop individualized care plans, and track outcomes against defined program goals.
• Strong written and verbal communication skills sufficient to produce audit-ready documentation and coordinate across clinical and non-clinical teams.
• Ability to manage multiple active cases simultaneously, prioritize competing demands, and meet documentation deadlines consistently.
• Proficiency in standard computer applications for data entry, case tracking, and report generation

• Certified Case Manager (CCM) designation, or active progress toward obtaining it within 24 months of hire.
• Experience in telephonic case management, call center operations, or remote member engagement within a managed care program.
• Familiarity with HMIS data entry standards or equivalent case management information systems used in housing or health program contexts.
• Prior experience supervising or mentoring case management staff, or leading performance improvement initiatives within a team setting.

• Caseload closure rate, measuring the proportion of assigned cases resolved within program-defined timeframes.
• Case audit pass rate, reflecting documentation accuracy against URAC or NCQA review criteria.
• Member eligibility verification turnaround, tracking how promptly eligibility status is confirmed and recorded per case.
• Escalation resolution time, measuring how quickly elevated clinical or member issues are routed and formally closed.
• Performance improvement plan completion rate, indicating timely follow-through on staff or case-level corrective actions.
• Typical tools: case management platforms (commonly HMIS or equivalent); productivity suites (commonly MS Word, MS Excel).

• Base Salary Range: $48,000 to $68,000 annually, depending on seniority and setting.
• Bonus: Annual performance bonus of 3% to 8% where applicable.
• Equity: Typically not offered at this level in healthcare settings.
• Health Benefits: Medical, dental, and vision coverage; employer contribution varies by organization.
• PTO: 15 to 20 days annually, plus standard federal holidays.
• Common Perks: Licensure reimbursement, CEU support, mileage or transportation allowance where field visits are required.

Candidates for this position are evaluated without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, or any other characteristic protected under applicable federal, state, or local law. Because this role involves contact with vulnerable populations, employment is contingent on successful completion of a background check, including criminal history and applicable child or adult protective services registry screening. Reasonable accommodations for qualified individuals with disabilities are available throughout the hiring process upon request. All applicants must be authorized to work in the United States.

The Case Management (Clinical Resource) owns clinical oversight and staff development across a managed care team, delivering coaching, auditing, and performance improvement for Nurse Case Managers, Disease Managers, and Non Clinical Support. Reporting to program leadership, this role shapes service quality by managing staff levels, conducting performance reviews, and ensuring clinical knowledge remains current across the team.

Key Responsibilities

• Serve as a clinical resource and coach for Nurse Case Managers, Disease Managers, Nurse Team Leads, and Non Clinical Support.
• Answer clinical questions from staff and resolve client issues.
• Provide ongoing training and education on clinical knowledge.
• Handle escalated issues when necessary.
• Provide updates and conduct meetings with clients as needed.
• Maintain staff levels, interview and hire employees, and enforce disciplinary actions.
• Conduct employee performance reviews.
• Conduct call monitoring and case auditing of staff, and implement performance improvement plans.

Required Qualifications

• Current, unrestricted RN licensure in the state of GA.
• Certified Case Manager (CCM) designation, or ability to obtain within 24 months.
• 3+ years of clinical experience as a RN, with 1+ year in hospital-based acute care; 2+ years of case and/or disease management experience.
• 3+ years of leadership experience, with ability to partner with staff to build high-performing teams; experience managing a large staff-to-manager ratio.
• Call center management experience and experience working in managed care or telephonic nursing.
• Knowledge of URAC and/or NCQA Clinical Standards.
• Strong people-management experience, including motivational leadership, performance improvement planning, and customer service orientation.
• Proficiency in MS Word and MS Excel, including ability to create documents and spreadsheets.
• Ability to manage metrics, multi-task effectively, and manage deadlines and task-oriented projects.

Embedded within the Emergency Response Team, the Rapid Deployment Case Management Advisor develops and implements case management structures during active disaster response operations, aligned to the Case Management framework and CRC Standards. Working closely with Operations and Site Managers, response leadership, and the National EM team, this role advances workforce readiness, service delivery quality, and capacity building across domestic operations and Canadian programs.

Core Functions

• Implement new assistance programs and ensure operational workforce assigned to case management functions has training and tools needed to provide timely and appropriate assistance to beneficiaries.
• Organize case management functions and coordinate with other ERT-Case Management Supervisors to manage logistics, interview space, data management, and referrals.
• Direct, coach, and coordinate case management workforce in delivering assistance, guidance, and orientation; assist the Operations/Site Manager and team with the transition between relief and recovery as a case management subject matter expert.
• Analyze and evaluate service delivery, recommend improvements to Manager-Case Management Operations Support and Operations/Site Manager, and participate in operational meetings with feedback and continuous improvement input.
• Manage expectations of directives, provide clarity on processes, and evolve best practices; function as and support multiple front-line roles as required, including direct supervisor, triage, and outreach.
• Monitor case management space for concerns, escalating situations, and gaps in service; brief/debrief workforce following challenging cases.
• Provide timely formal and informal performance feedback, coaching, and development planning to team members, volunteers, and employees as assigned.
• Identify and analyze needs of affected communities and gaps in existing capacity; implement and monitor case management metrics focused on effectiveness, timeliness, and quality.
• Support case management projects and capacity building across Canada when not engaged in active operations; contribute to a healthy and safe working environment.
• Share and promote best practices across the EM team and support monitoring of ongoing operations in collaboration with the National EM team.
• Participate in the development and preparation of program objectives and implementation plans; provide regular and timely operational reports as required.

Qualifications & Experience

• University degree in disaster management, community development, social work, psychology, or related discipline; or equivalent combination of education and experience, with 2–3 years in case management or a related field.
• Experience working in or leading a case management team during a response operation; experience managing diverse teams in complex situations.
• Experience in psychological first aid (PFA) and/or skills for psychological recovery (SPR) and working with Indigenous communities or groups with unique vulnerabilities preferred.
• Experience in the development of tools, resources, and standards specific to response and/or case management; experience in housing repair/reconstruction or other specialized recovery services preferred.
• Strong knowledge of case management principles including use of the EMIS database and ability to lead others through best practices.
• Strong computer skills including Word, Excel, and PowerPoint; knowledge of systems including EMIS.
• Strong verbal and written communication, organizational, and multi-tasking skills; ability to work effectively in fast-paced, ambiguous environments under tight timelines.
• Fluent in both English and French (written and oral) preferred; additional languages an asset.

Reporting to the Hub Team Lead, the Third Party Risk Case Management Senior refines the organization's approach to vendor risk by managing a complex portfolio of third party engagements and mentoring TPRM Case Managers through due diligence, regulatory compliance, and process improvement. Partnering with First and Second Line of Defence stakeholders across global Hub locations, this role advances consistency in risk assessment practices and contributes directly to the integrity of the bank's third party governance framework.

Primary Duties

• Manage a portfolio of third party engagements, completing risk assessments and associated due diligence using HSBC's risk management tool Archer and other internal systems.
• Serve as single point of contact for the business, proactively managing end-to-end engagements and ensuring timely completion of actions; build understanding of engagements, services, and associated risks across business and spend categories.
• Engage all necessary internal and external stakeholders across First and Second Line of Defence as required; ensure the business operates in line with required frameworks, regulatory and industry standards, and HSBC Policies and FIMs.
• Document summary views of activities performed and residual risks to support informed business decisions against risk appetite; escalate issues timely to Hub Team Lead or Subject Matter Expert.
• Contribute to design and process improvements by providing feedback, suggestions, and leading initiatives; maintain HSBC internal control standards and implement audit points.
• Mentor, train, support, and resolve issues for TPRM Case Managers; engage in complex cases and disputes with TPEM and TPROs.
• Work with peers across all Hub locations to ensure consistency and promote a continuous improvement environment; act as a trusted partner building trust and credibility through integrity and professionalism.
• Ensure appropriate trainings are completed to be proficient in the role and continuously engage in additional trainings to build knowledge and skills.
• Share knowledge and best practices with the TPRM Case Managers and team; work collaboratively and communicate persuasively, emphasising teamwork, diversity, and knowledge-sharing.

Skills & Qualifications

• Experience within a risk management role, preferably third party management; financial services, regulatory agency, or major consulting firm experience desirable.
• Experience managing a complex portfolio of work and simple projects to time and quality.
• Good understanding of Global Businesses and Global Functions within a bank, regional regulatory environment, and third party risk; understanding of 1+ Risk Domains desirable.
• Prior quality assurance or audit experience in procurement or supplier relationships beneficial.
• Excellent communication, coaching, and influencing skills with peers, subordinates, and suppliers; strong problem-solving and mentoring ability.
• Proficient in MS tools with excellent written and verbal communication skills; attention to detail and proactive awareness of internal and external policies.

Sitting at the intersection of child welfare and family placement services, the Adoption Case Management Specialist leads family assessments, adoptive placements, and post-placement supervision in compliance with agency guidelines, state licensing requirements, and federal regulations. Operating with moderate supervision and collaborating with adoption planning and birth parent counseling staff, this role ensures that every child placement is supported by thorough documentation, court-compliant reporting, and ongoing family guidance through legal confirmation.

Duties

• Provide comprehensive case management from intake through adoptive placement and supervision of legal confirmation.
• Review pre-adoptive applications and assess qualifications of potential adoptive families; perform home studies in accordance with agency expectations.
• Facilitate training sessions designed to help adoptive families meet licensing requirements and conduct adoption group informational meetings for prospective families.
• Administer placements of children for studied and approved families; provide post-adoptive supervision during the supervisory year.
• Submit post-placement reports in a timely manner and ensure adoption closings are completed by the court-recommended schedule.
• Assist in adoption planning sessions with adoption and birth parent counseling staff; promote the adoption program through speaking engagements at community groups.
• Organize and manage time to ensure all reports and documents are completed on time and included in appropriate adoption records.
• Attend weekly supervisor meetings, participate in the on-call system, and attend training as needed to apply newly gained knowledge.

Education & Experience

• Bachelor's degree in Social Sciences, Human Services, Behavioral Science, or equivalent from an accredited college.
• At least one (1) year of experience in child welfare strongly preferred.
• Obtain and maintain appropriate professional licensure and registration within the program's respective state.
• Demonstrated clinical, therapeutic, and crisis intervention skills; ability to work independently with a high level of confidentiality.
• Must exhibit ability to apply principles of logic and critical thinking in problem solving; ability to work well under pressure and adapt to change.
• Excellent verbal and written communication skills; computer and typing skills sufficient to perform essential job functions.
• Active motor vehicle license and reliable automobile with adequate insurance coverage.
• Pass criminal history screen, including state and local child protection agency registries; subscription to agency Statement of Faith, Mission Statement, and Cultural Diversity Commitment.

A key member of the case management operations team, the Case Management Representative delivers client-centered service by handling case assignments, verifying chain of custody requirements, and processing affidavits and final reports within a forensic or life sciences service environment. Collaborating across departments and reporting to program leadership, this role ensures every case reaches accurate closure while meeting weekly production targets and data integrity standards.

Accountabilities

• Coordinate and provide service that is timely, effective, efficient, equitable, and client-centered.
• Handle case assignments, review case progress, and determine case closure.
• Intake packages received daily, verify package integrity, and confirm chain of custody requirements.
• Identify complete and partial cases; perform data entry and audit of all patient and contract information.
• Input partial billing information and meet weekly required production numbers.
• Prepare affidavits, perform limited notarization, and close and mail final reports, chain of custody documents, and affidavits.
• Collaborate effectively with others and attend and participate in staff meetings.

Requirements

• High School diploma/GED required; Biology and/or Life Science studies experience preferred.
• One (1) to two (2) years of previous data entry service preferred.
• High degree of accuracy, strong attention to detail, excellent data entry and organizational skills, and strong listening skills and patience.
• Excellent communication, customer service, interpersonal, and typing skills; strong planning, organizational, time, and project management skills.
• Ability to multi-task, prioritize workload, remain flexible to changing priorities, and work with minimal supervision as well as part of a team.
• Computer literacy in Microsoft Office is a plus; knowledge of good record-keeping requirements is a plus.
• Good problem-solving skills, demonstrated ability to work cross-functionally, and proven ability to interact with all organizational levels.
• Ability to demonstrate and uphold the highest levels of ethical behavior and confidentiality.

The Case Management and Employee Relations Intern leads administrative coordination of complex sickness absence cases, supporting the case management team in maintaining compliance with the Dutch Gatekeeper Act and company internal policies. The team depends on this intern to keep files current, assign new cases, and ensure employees and people managers receive timely advice and status updates that support sustainable reintegration.

Scope of Work

• Support absence guidance and help ensure compliance with the Dutch Gatekeeper Act and company internal policies.
• Act as a first point of contact for questions and support administrative duties.
• Provide employees and people managers with advice, instructions, and status updates to support sustainable reintegration.
• Keep files up-to-date, assign new cases, and manage communication with internal and external stakeholders.
• Proactively identify areas for improvement in sickness management and bring forward policy and process improvement suggestions.
• Provide project management support to centralise the sick leave process and create more effective and efficient ways of managing long-term sick leave.

Position Requirements

• Currently studying for a Bachelor's or Master's degree or higher in Human Resources, Business Administration, or Organisational Psychology.
• Available full-time for a period of 6 months.
• Strong interest in Wellbeing, Sickness Management, and Case Management (Wet Verbetering Poortwachter).
• Strong analytical skills; organised with great attention to detail and highly motivated.
• Self-starter who actively seeks feedback and development opportunities and is flexible; able to work collaboratively with the team to ensure all activities are managed efficiently and accurately.
• Fluent or nearly fluent in English; fun, open-minded, and comfortable working in an international multicultural environment.

As the Case Management Specialist, this role delivers end-to-end support for employees lodging workers' compensation claims, gathering evidence, liaising with medical professionals, and approving or rejecting claims based on available findings. The claims and customer service team relies on this work to ensure every claimant receives consistent follow-up and that internal stakeholders are kept informed throughout the claim progress.

Functions

• Answer new enquiries and gather evidence about the claim.
• Reassure the customer of available assistance and support.
• Speak with the employer, medical professionals, and other relevant experts.
• Approve or reject claims based on available evidence.
• Work in a tight team environment to achieve the best outcomes possible.

Experience & Qualifications

• Passion for exceptional customer service with strong phone-based communication skills.
• Good numerical skills and ability to juggle multiple tasks simultaneously.
• Proficiency with a variety of computer or POS systems and good general PC skills.
• Ability to work collaboratively in a team and find effective solutions to problems.
• Comfort working in a fast-paced environment and handling a high volume of interactions.

Case Management Supervisor manages the daily clinical oversight, staff supervision, and regulatory compliance of shelter-based case management services, including rapid re-housing and Housing First programs aligned with the HEARTH act and City of Alexandria standards. Success in the position means recruiting, training, and evaluating a team of case managers and interns, maintaining HMIS data integrity, and ensuring Individualized Program Plans support residents from intake through discharge in partnership with the Executive Program Director and community agencies.

Leadership Responsibilities

• Oversee the overall supervision, training, and operational management of the case management program and staff.
• Directly manage recruitment, supervision, and implementation of case management services; monitor and approve payroll for case management staff.
• Analyze data to review trends and make course adjustments to service delivery to ensure clients are served in a holistic, individual approach.
• Provide consultation regarding residents' Individualized Program Plans from intake through discharge; participate in application review and interview process of potential residents.
• Establish and maintain effective working relationships with City of Alexandria staff and local community agencies and resources; act as liaison between programs and funding/regulatory agencies.
• Ensure complete program records are generated and maintained in accordance with policies, procedures, and contractual and regulatory requirements.
• Conduct internal audits of files and HMIS data to ensure quality and compliance with City of Alexandria Standards; provide on-call coverage as scheduled.
• Ensure effective resident and staff meetings are conducted; conduct pre-service and in-service training, supervise interns, and provide ongoing clinical support to staff in accordance with the HEARTH act.

Minimum Qualifications

• Valid driver's license in jurisdiction of residence; vehicle liability coverage if driving personal vehicle.
• CPR/First Aid Certification must be acquired and maintained once employed.
• Acceptable EBI background, FBI Fingerprint, Child Protective Services, OIG Exclusion check; negative Drug/TB Screening.
• Ability to safely operate a motor vehicle to transport oneself, consumers, and program supplies.
• May be required to drive a van of up to 15 passengers.
• Physical ability to travel to assigned locations, stand, stoop, bend, reach, lift objects up to 30 pounds, and operate office equipment with continuous hand/arm movements.
• Ability to remain in a sitting position for extended periods of time.

Reporting to the Centre Manager, the Career Coach produces individualized employment action plans and delivers one-to-one coaching on resume writing, labour market information, and financial support eligibility within a WorkBC employment services setting. Partnering with clients, community partners, and the broader coaching team, this role contributes to monthly Key Performance Measures and Centre targets while operating under ISO9001:2015 quality standards.

Day-to-Day Responsibilities

• Create realistic action plans identifying activities and goals that support clients in reaching employment.
• Assist clients through one-to-one coaching with resume writing, job search techniques, labour market information, career planning materials, assessment tools, and workshops.
• Determine eligibility for financial supports and services; assess and provide clients with tailored services based on individual needs.
• Maintain regular contact with clients to support, motivate, and monitor progress.
• Review monthly Key Performance Measures and Centre targets with the Centre Manager to ensure the right services are delivered at the right time.
• Participate in weekly team meetings, strategic planning sessions, and performance management reviews.
• Work to Training Group's Quality Management System, ISO9001:2015 standard; perform resource area assistance including reception on occasion.

Professional Experience

• Post-secondary degree or equivalent level of knowledge and experience in an employment services-related field.
• Certified Career Development Practitioner (CCDP) certification an asset.
• Experience providing excellent customer service in person and virtually; experience conducting and interpreting client needs assessments; experience working with individuals with complex barriers and diverse cultural backgrounds preferred.
• Knowledge of local labour market and labour market trends; knowledge and awareness of WorkBC systems, processes, and financial model an asset.
• Excellent computer skills including MS Office Suite, database entry, and online meeting and desktop-sharing applications.
• Strong oral and written communication and interpersonal skills; ability to exhibit respect for clients, client diversity, and community partners.

The Case Management Sr. Representative delivers inbound and outbound member contact to complete Health Risk Assessment surveys, verify member eligibility, and channel non-clinical data to appropriate staff within a managed care contact center environment. Collaborating with internal teams and external providers under established case management policies and quality assurance standards, this role supports accurate data collection and consistent service across a high-volume call operation.

Key Deliverables

• Make and receive outbound/inbound phone calls from customers completing Health Risk Assessment surveys; enter data from mailed-in surveys.
• Communicate internally and externally to provide, verify, and explain information and processes with courtesy and professionalism.
• Access systems to collect and enter non-clinical data; verify member eligibility.
• Determine course of action based on pre-established guidelines and channel to appropriate staff as needed.
• Perform outbound calls to providers to request additional information on an as-needed basis.
• Adhere to quality assurance standards and all case management policies and procedures; perform other non-clinical functions as assigned.

Background & Experience

• High School diploma or GED equivalent.
• 0–2 years of prior experience in a customer service role or operation.
• Working knowledge of medical terminology and coding as it relates to specialty services; working knowledge of Cigna technology and telephone systems preferred.
• Basic computer skills including MS Word, Excel, and Outlook.
• Strong telecommunications and customer service skills; ability to work independently, make independent decisions, and work unsupervised on special projects.
• Ability to adapt and be flexible in a fast-paced, high-volume contact center environment and function as part of a team to achieve common goals.
• Time management and priority-setting skills; demonstrated leadership skills and ability to participate in or lead projects and workflow improvement initiatives.