The Case Manager assumes responsibility for the coordination of services in order to maximize patient outcomes. Inherent in the position is assessment, evaluation, collaboration and coordination of patient care delivery systems and participation in appointed service line activities. Emphasis is on cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient population. The Case Manager is responsible for the coordination of utilization management, discharge planning and other health care services/systems. The Case Manager functions as a contact person, coordinator and facilitator for the patient, family, health care team members, and claims/insurance personnel as necessary.

typical roles and responsibilities for Case Manager

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed with or without prior notice based on the needs of the organization.

  • Maintains a safe, clean working environment, including unit based safety and infection control requirements.
  • Responsible for the coordination of services in order to maximize patient outcomes.
  • Assess, evaluate, collaborate and coordinate patient care delivery systems and participation in appointed service line activities.
  • Ensures cost-effective and cost-efficient strategies which maximize quality care within the current health care environment for the identified patient population.
  • Responsible for the coordination of utilization management, discharge planning and other health care services/systems.
  • Functions as a contact person and facilitator for the patient, family, health care team members and claims/insurance personnel as necessary.
  • Responsible for direct admission process and bed assignments for direct admission patients (may include patients admitted from Physician’s office or transferred to TCMC from other health care facilities – ED department only).
  • Required to cover two holiday shifts per year or as needed.
  • Coordinates services to maximize patient outcomes.

Requirements for Case Manager – Hospital

  • Minimum of 3 years clinical and case management experience in acute care setting, preferred.
  • Knowledge of Prospective Payment System and JCAHO standards and regulatory requirements pertaining to Utilization Management and Discharge Planning desirable.
  • Ability to communicate effectively utilizing both written and verbal skills. Education
  • Bachelors Degree in nursing or other health related field, preferred. Licenses
  • Current California Registered Nurse, required.
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