Manager, Case Management

Sign On Bonus and Relocation available!

Overview
We are seeking a dynamic and experienced Manager of Case Management to lead our dedicated team in delivering exceptional patient care coordination across diverse healthcare settings. In this vital role, you will oversee the development and implementation of comprehensive care plans, ensuring seamless discharge planning, utilization review, and adherence to regulatory standards. Your leadership will drive improvements in patient outcomes, optimize resource utilization, and foster a collaborative environment that prioritizes compassionate, patient-centered care. This position offers an exciting opportunity to influence healthcare delivery at a strategic level while working closely with multidisciplinary teams to meet organizational goals.

Responsibilities

• Lead and supervise the case management team, providing guidance, mentorship, and performance evaluations to ensure high-quality patient care delivery.
• Develop and oversee individualized care plans that incorporate medical, behavioral health, social work, and discharge planning components aligned with NCQA standards and Medicare requirements.
• Coordinate with hospital departments—including ICU, Emergency Medicine, Pediatrics (PICU), and Behavioral Health—to facilitate effective patient assessments and ensure timely interventions.
• Conduct comprehensive reviews of medical records and documentation to verify compliance with HIPAA regulations and ensure accurate data collection for quality improvement initiatives.
• Oversee utilization review processes to optimize hospital resources while maintaining compliance with accreditation standards such as NCQA and CMS guidelines.
• Collaborate with physicians, nurses, social workers, addiction counselors, and other healthcare professionals to support complex case management needs across Level I and Level II trauma centers.
• Manage discharge planning activities by coordinating post-acute services such as home health, hospice care, or outpatient therapies to promote smooth transitions of care.
• Monitor key performance indicators related to patient care, documentation review, behavioral health integration, and managed care metrics to continuously improve service quality.
• Ensure team adherence to medical terminology standards, physiology and anatomy knowledge requirements, and behavioral therapy protocols in all case management activities.

Skills

• Extensive hospital experience across various departments including ICU, emergency medicine, pediatrics (PICU), trauma centers (Level I & II), and acute care settings.
• Strong nursing background with expertise in discharge planning, medical records management, and documentation review.
• Proven leadership skills with supervising experience in case management or related healthcare roles; ability to motivate teams toward excellence.
• Deep understanding of HIPAA regulations coupled with experience in data collection and analysis for quality assurance purposes.
• Knowledge of behavioral health practices including mental health counseling and behavioral therapy integration within case management processes.
• Familiarity with managed care principles, Medicare policies, NCQA standards, and utilization review procedures.
• Excellent communication skills for effective collaboration with multidisciplinary teams and external providers; adept at patient assessment and social work coordination.

Pay: $95,000.00 - $105,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Relocation assistance
• Vision insurance

Experience:

• hospital social work: 5 years (Preferred)
• supervisory/leadership: 3 years (Preferred)
• InterQual: 2 years (Preferred)

License/Certification:

• LCSW or a LMSW (Preferred)

Work Location: In person

Salary : $95,000 - $105,000