Case Manager

Case Manager

The case manager is responsible for overseeing complex patient cases, providing expert care coordination and driving quality outcomes. This role assesses patient needs, develops and implements care plans, and collaborates with healthcare teams to ensure seamless transition and optimal care with a focus on disease management.

Essential duties and responsibilities include:

• 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 participate in census management, identifying patients with high utilization patterns.
• Identify root causes of admissions and develop targeted interventions to mitigate risk.
• Create and execute plans of care to address needs and prevent future admissions.
• Analysis of data and metrics to inform care decisions and drive outcomes.
• Lead or participate in care planning meetings and case conferences.
• Provide education and support to patients and families on care plans and self-management strategies and disease management progress.
• Identify and address barriers of care, then escalate issues as needed.
• Stay up to date on regulation requirements, best practices, and industry trends in disease management.
• Mentor or supervise junior care coordinators.
• Participate in quality improvement initiatives and special projects.

Must be detail-oriented, possess the ability to multi-task/problem solve, and be open to cross-functional training. Exercise proper phone etiquette and navigate computer software systems proficiently. Be team-oriented and work well with patients, colleagues, physicians, and other personnel in a professional and courteous manner. Have 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.