Case Manager

Case Manager Overview

• The Case Manager role focuses on coordinating care and resources for members to achieve optimal clinical and resource outcomes.
• Utilize clinical expertise to perform comprehensive assessments and collaborate on treatment plans and interventions.
• Develop member-centric plans tailored to individual needs, health status, and support requirements.
• Leverage community resources and funding sources to enhance care plans effectively.
• Monitor and manage members’ progress, ensuring timely follow-ups and appropriate referrals.
• Evaluate and facilitate care across various settings, including hospitals, rehabilitation units, and home care.
• Document all aspects of care plans, from initial assessment to outcome evaluation.
• Outreach to high-risk or high-cost cases, reviewing alternative treatment plans and assessing benefits.
• Develop policies, procedures, and training materials to support internal and external stakeholders.

Case Manager Key Responsibilities & Duties

• Coordinate care and resources for members, ensuring optimal clinical outcomes and cost-effectiveness.
• Perform comprehensive assessments to guide treatment plans and interventions.
• Develop tailored care plans addressing members’ needs and barriers to achieving goals.
• Utilize community resources and funding sources to enhance care plans.
• Monitor member progress, adjusting plans and goals as necessary based on acuity.
• Educate members on proactive interventions to improve outcomes and reduce expenses.
• Document all aspects of care plans, ensuring accuracy and completeness.
• Outreach to high-risk cases, assessing alternative treatment plans and benefits options.
• Develop policies, procedures, and training materials to support case management practices.

Case Manager Job Requirements

• Bachelor of Science in Nursing (BSN) required; valid clinical license (NC or compact multi-state).
• Minimum of 3 years of clinical and/or case management experience; 5 years preferred.
• Specialty certifications such as CCM or CDCES may be required within 2 years.
• Experience in behavioral health roles with applicable licensure is advantageous.
• Strong knowledge of community resources and funding sources for care planning.
• Proficient in developing and documenting comprehensive care plans and interventions.
• Ability to evaluate medical necessity and appropriateness of services effectively.
• Skilled in educating members on proactive interventions and positive outcomes.
• Experience in policy development and training for case management practices.