Manager, Case Management

Responsible for the leadership, oversight, and daily operations of outpatient case management and care coordination programs. Directs a multidisciplinary team focused on improving patient outcomes, enhancing continuity of care, reducing unnecessary hospitalizations and emergency department utilization, and supporting value-based care initiatives. Collaborates with providers, clinical staff, community partners, and organizational leadership to ensure high-quality, patient-centered care while meeting quality, utilization, and financial performance goals.

Responsibilities

• Lead and supervise outpatient case management, care coordination, and population health programs.
• Manage and mentor a multidisciplinary team, including Case Managers, Social Workers, Transitional Care Nurses, Care Coordinators, and Support Staff.
• Establish performance expectations, conduct evaluations, and support staff development and training.
• Monitor program effectiveness and implement process improvements to enhance operational efficiency and patient outcomes.
• Ensure compliance with organizational policies, regulatory requirements, and value-based care standards.
• Oversee care management services for high-risk, complex, and chronically ill patient populations.
• Direct transitional care management activities for patients discharged from hospitals, skilled nursing facilities, rehabilitation centers, and behavioral health facilities.
• Ensure timely follow-up appointments, medication reconciliation, home health services, durable medical equipment coordination, and specialist referrals.
• Develop strategies to reduce preventable emergency department visits, hospital admissions, and readmissions.
• Facilitate collaboration among providers, patients, caregivers, and community resources to support comprehensive care plans.
• Utilize clinical and operational data to identify population health needs and care gaps.
• Develop and implement programs that improve quality metrics, patient engagement, and health outcomes.
• Support value-based care initiatives and organizational performance objectives.
• Monitor utilization trends and identify opportunities to increase appropriate outpatient management.
• Collaborate with leadership to achieve quality, utilization, and financial goals.
• Provide education and resources to patients, providers, and staff regarding care management and value-based programs.
• Foster strong relationships with healthcare providers, hospitals, community agencies, and other key stakeholders.
• Serve as a resource and advocate for patients navigating the healthcare system.
• Support organizational initiatives and strategic goals through effective communication and collaboration.

Requirements

Education

• Registered Nurse.
• Bachelor's Degree in Nursing (BSN) or Master's Degree in Nursing, Healthcare Administration, Public Health, or related field preferred.

Experience

• Minimum of 3-5 years of clinical case management, care coordination, or population health experience.
• Minimum of 2 years of leadership or supervisory experience in a healthcare setting preferred.
• Experience with outpatient care management and value-based care programs strongly preferred.

Licensure & Certifications

• Current Registered Nurse (RN) license in good standing.
• Certified Case Manager (CCM) preferred.

Skills & Abilities

• Strong leadership, organizational, and team management skills.
• Knowledge of case management principles, utilization management, and transitional care.
• Understanding of population health and value-based reimbursement models.
• Ability to analyze clinical and operational data and implement performance improvement strategies.
• Excellent communication, interpersonal, and relationship-building skills.
• Proficiency with Electronic Medical Records (EMR/EHR) and Microsoft Office applications.
• Ability to manage multiple priorities and work effectively in a fast-paced environment.

Core Competencies

• Leadership & Staff Development
• Population Health Management
• Care Coordination
• Transitional Care Management
• Quality Improvement
• Utilization Management
• Strategic Planning
• Data Analysis & Reporting
• Patient Advocacy
• Team Collaboration
• Regulatory Compliance
• Results-Oriented Performance Management

Physical Requirements

• Ability to sit, stand, and walk for extended periods.
• Occasional travel to clinics, provider offices, and community locations.
• Ability to lift and carry up to 10 pounds as needed.

Pay

The anticipated base salary range is $85,159.00 to $127,738.00. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.