WHAT DOES A CLINICAL CASE MANAGER DO?
Updated: Nov 21, 2024 - The Clinical Case Manager brings extensive case management experience, ideally with homeless populations, and a profound commitment to addressing the challenges faced by families affected by violence and homelessness. Expertise includes professional health and human services settings, with a strong grasp of local health and social services care coordination, including eligibility assistance. Additionally, the role demands excellent interpersonal communication skills, with a preference for candidates possessing knowledge in HIV direct care and Utilization Review.
A Review of Professional Skills and Functions for Clinical Case Manager
1. Clinical Case Manager Duties
- Veterans Care Coordination: Coordinate care through the Department of Veterans Affairs for Veterans, including liaising with GPs as needed on documentation.
- Eligibility Determination: Determine eligibility for other externally funded care services.
- Healthcare Liaison: Liaise with the resident’s general practitioner and other health care service providers.
- Comprehensive Assessment: Conduct or oversee comprehensive assessment of resident’s care and service needs following entry.
- Focused Assessment: Conduct focal assessments as indicated.
- Allied Health Coordination: Arrange for assessment by allied health professionals.
- Legal Documentation Handling: Obtain Enduring Power of Attorney documentation and liaise with legal representatives.
- Care Management: Liaise with the Village Care Manager to ensure residents receive the care and service they require to meet identified goals, needs, and preferences.
- Feedback Integration: Ensure feedback from the care team is used to update care plans and run sheets.
- Care Monitoring: Monitor the care team to ensure that care is delivered in accordance with run sheets.
2. Clinical Case Manager Details
- Documentation Skills: Ensure variances to planned care are documented, monitored, and that the care plan is updated accordingly and agreed to by the resident (or representative).
- Care Monitoring: Monitor unplanned care to determine whether the care plan requires changes.
- Clinical Review: Conduct ongoing clinical review and case management of all care recipients at scheduled intervals.
- Direct Care Provision: Provide direct resident care as directed by the Village Care Manager.
- On-Call Support: Provide on-call support to the shift RNs, when rostered.
- Relationship Management: Maintain effective and harmonious relationships with residents, families, and representatives.
- Professional Liaison: Liaise with doctors and allied health providers.
- Network Establishment: Establish an effective network of health and community services and providers.
- Cost Management: Ensure a timely and cost-effective manner in obtaining optimum value for both the client and the reimbursement source.
- Care Level Assessment: Assist in identifying the appropriate level of care, appropriate providers, and facilities.
3. Clinical Case Manager Responsibilities
- Clinical Expertise: Serves as expert Clinical co-manager on behavioral health claims from day 1 of STD claims and provides activities requiring clinical expertise.
- Provider Interaction: Perform provider interviews and analyze clinical information submitted.
- Negotiation Skills: Negotiate return to work plans with employee, treating provider, and employer if applicable.
- Investigative Skills: Investigate and resolve inconsistencies in the level of cognitive, emotional, or behavioral functioning depicted in clinical information submitted.
- Strategy Coordination: Coordinate a strategy to determine the true level of functional capacity utilizing direct contact with the treating provider and/or utilizing internal clinical resources (e.g., Peer-to-Peer Reviews, internal impairment guides, round table reviews, etc.).
- Consultation: Acts as a behavioral health consultant to the Appeals Unit.
- Resource Provision: Act as a resource to Operation staff when handling claimants noted to be threatening harm to themselves or others.
- Referral Facilitation: Facilitate referrals to collateral internal and external services, e.g., EAP, disease management programs, Advocacy, care managers, etc., as applicable.
- Quality Monitoring: Coordinate and monitor the quality of behavioral health IME's as applicable.
- Barrier Identification: Identify barriers for employees to return to work as well as identifying and prompting optimal health care to facilitate an appropriate and timely return-to-work.
4. Clinical Case Manager Accountabilities
- Clinical Practice: Provides quality clinical care through evidence-based practices with adults.
- Treatment Planning: Develop short-term treatment plans and coordinate discharge plans.
- Advocacy: Act as an advocate for the needs and interests of the patient and family/support system by supporting self-determination and autonomy.
- Collaborative Care: Create strength-based, collaborative care planning with the patient and family/support systems.
- Communication Skills: Provide clear and concise communication through consultation, education, facilitation, and team organization to patients and family/support system.
- Legal Liaison: Communicate with legal systems, schools, and social service agencies and provide court testimony.
- Healthcare Management: Assess, plan, implement, monitor, and evaluate options and services required to meet an individual’s health needs.
- Resource Utilization: Utilize a collaborative process and use communication and available resources to promote quality, cost-effective outcomes.
- Return-to-Work Planning: Strategize with claimants, treating providers, and employers on possible accommodations or restrictions to facilitate transitional return-to-work plans.
5. Clinical Case Manager Functions
- Collaboration: Work closely with volunteer house parents in a transitional housing program, foster families, and Outreach staff
- Support Services: Provide supportive housing to young adults and help launch them into independent, productive lives.
- Case Management: Case management with each resident to assess, plan, and implement changes needed for future success and independent living.
- Community Engagement: Maintain and develop relationships with foster host homes within the community to offer more housing options for homeless young adults.
- Youth Support: Work with at-risk homeless youth and young adults in the community
- Assistance Provision: Assist with basic needs and steps toward a more secure future.
- Regulatory Compliance: Ensure compliance with DCFS licensing standards and grant requirements.
- Team Participation: Reports to the Director of Wheaton Youth Outreach and participates as a member of the broader transitional housing and Wheaton Youth Outreach staff teams.
- Compliance Reporting: Reporting non-compliance to the Court and conduct psycho-social assessments
- Treatment Follow-up: Monitor clients’ compliance with treatment as indicated by follow-ups with clients at home and with community providers.
Editorial Process and Content Quality
This content is part of Lamwork's career intelligence platform and is developed using structured analysis of real-world job data, including publicly available job descriptions, skill requirements, and hiring patterns.
Lam Nguyen, Founder & Editorial Lead, defines the research framework behind Lamwork's career intelligence platform, including job role analysis, skills taxonomy, and structured career insights.
All content is reviewed by Thanh Huyen, Managing Editor, who oversees editorial quality, content consistency, and alignment with real-world role expectations and Lamwork's editorial standards.
Content is developed through a structured process that includes data analysis, role and skill mapping, standardized content formatting, editorial review, and periodic updates.
Content is reviewed and updated periodically to reflect changes in skills, role requirements, and labor market trends.
Learn more about our editorial standards.