Case Manager

Essential Duties and Responsibilities

• Conduct comprehensive patient assessments to identify needs and develop individualized care plans.
• Collaborate with healthcare providers, families, and stakeholders to coordinate care and services.
• Develop and implement Disease Management plans for patients with chronic conditions (e.g.: diabetes, hypertension, asthma/COPD, heart failure, CKD).
• Actively participates in census management, identifying patients with high utilization patterns.
• Identifies root causes of admissions and develops targeted interventions to mitigate risk.
• Creates and executes plans of care to address identified needs, preventing future admissions.
• Analyzes data and metrics to inform care decisions and drive outcomes.
• Leads or participates in care planning meetings and case conferences.
• Provides education and support to patients and families on care plans and self-management strategies and disease management progress.
• Identifies and addresses barriers of care, escalating issues as needed.
• Stays up to date on regulatory requirements, best practices, and industry trends in disease management.
• Mentors or supervises junior care coordinators.
• Participates in quality improvement initiatives and special projects.

Qualifications

• Detail-oriented, able to multi-task and problem solve.
• Open to cross-functional training.
• Proficient in phone etiquette and computer software systems.
• Team-oriented and works well with patients, colleagues, physicians, and other personnel in a professional and courteous manner.
• Exceptional organizational skills with the ability to prioritize and complete tasks in a timely manner.
• Knowledge of medical terminology, CPT, HCPCS, and ICD coding preferred.
• Bilingual is a plus.