Case Management Nurse

The Case Management Nurse is responsible for coordinating comprehensive patient care to ensure high-quality, cost-effective outcomes. This role involves assessing, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet each patient's health needs. The Case Management Nurse serves as a key liaison among patients, families, healthcare providers, and payors to facilitate optimal care and resource utilization.

Key Responsibilities

• Conduct comprehensive assessments of patients' medical, psychosocial, and discharge needs.
• Develop individualized care plans in collaboration with the healthcare team, patient, and family.
• Coordinate and monitor patient care across the continuum—from admission to discharge and post-discharge follow-up.
• Ensure appropriate utilization of healthcare resources while maintaining quality standards.
• Facilitate communication between interdisciplinary teams, payors, and external service providers.
• Evaluate patient progress toward goals and modify care plans as needed.
• Identify and address barriers to care or discharge planning.
• Provide education and support to patients and families regarding treatment plans and community resources.
• Document all case management activities accurately and timely in compliance with organizational and regulatory standards.
• Participate in quality improvement initiatives and data reporting related to case management outcomes.

Qualifications

Education & Licensure:

• Registered Nurse (RN) license in (State/Region).
• Bachelor of Science in Nursing (BSN) preferred.
• Case Management Certification (CCM, ACM-RN, or equivalent) preferred.

Experience:

• Minimum of 2–3 years of clinical nursing experience (hospital, acute care, or related setting).
• Prior experience in case management, care coordination, or discharge planning strongly preferred.

Skills & Competencies:

• Strong clinical assessment and critical thinking skills.
• Excellent communication, negotiation, and problem-solving abilities.
• Proficiency in electronic medical records (EMR) systems.
• Knowledge of healthcare regulations, reimbursement systems, and community resources.
• Ability to work independently and as part of a multidisciplinary team.
• Compassionate, patient-centered approach with strong organizational skills.

Work Environment

• Typically works in a hospital, clinic, or managed care setting.
• May involve occasional travel for home visits, community outreach, or inter-facility coordination.
• Standard office hours with occasional weekend or on-call requirements depending on patient needs.

Job Type: Full-time

Base Pay: $55,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person