Job Description Summary

The Case Management Manager is responsible for the leadership, oversight, and daily operations of outpatient case management and care coordination programs. This role 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. The Manager 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.

How will you make an impact & Requirements

Professional Summary

Registered Nurse and healthcare leader with extensive experience in outpatient case management, care coordination, population health, and value-based care programs. Proven success leading multidisciplinary teams to improve patient outcomes, reduce avoidable emergency department utilization and hospital readmissions, and enhance quality performance measures. Skilled in transitional care management, utilization management, chronic disease management, provider education, and care continuum coordination. Strong analytical, operational, and leadership abilities with expertise in implementing value-based initiatives, leveraging healthcare data, and driving organizational quality and financial goals.

Core Competencies

• Outpatient Case Management
• Value-Based Care Programs
• Population Health Management
• Transitional Care Management
• Utilization Management
• Care Coordination
• Readmission Reduction Strategies
• Emergency Department Diversion
• Quality Measures & HEDIS Performance
• Team Leadership & Staff Development
• Provider and Staff Education
• Performance Improvement
• Social Services Coordination
• Home Health & Community Resource Management
• Healthcare Analytics & Reporting
• Regulatory Compliance
• Electronic Medical Records (Athena, EMR/EHR)
• Strategic Planning & Program Development

Professional Experience

Case Management Manager / Value-Based Care Manager

Employer Name | City, State | Dates

• Directed daily operations of outpatient case management and value-based care programs, ensuring efficient delivery of patient-centered services across multiple care settings.
• Led multidisciplinary teams including Case Managers, Social Workers, Transitional Care Nurses, ER Follow-Up Coordinators, and Home Health Coordinators.
• Developed and implemented population health initiatives that improved care outcomes for high-risk and chronic disease populations.
• Oversaw care transitions following hospital, skilled nursing, rehabilitation, and behavioral health discharges to ensure continuity of care and timely provider follow-up.
• Reduced avoidable emergency department visits and hospital readmissions through proactive case management interventions and patient engagement strategies.
• Utilized clinical and utilization data to identify high-risk patients, gaps in care, and opportunities for improved outpatient management.
• Collaborated with physicians, providers, and community partners to coordinate comprehensive care plans and improve patient outcomes.
• Monitored quality metrics and value-based performance measures, driving continuous improvement initiatives and compliance with payer requirements.
• Facilitated provider and staff education on value-based care programs, care coordination workflows, and quality improvement initiatives.
• Participated in interdisciplinary committees, operational meetings, and strategic planning sessions to support organizational goals and financial performance.
• Managed implementation of new clinical workflows and operational improvements to enhance efficiency and patient satisfaction.
• Built strong relationships with healthcare partners, community organizations, and ancillary service providers to expand patient support resources.

Registered Nurse Case Manager

Employer Name | City, State | Dates

• Conducted comprehensive assessments and developed individualized care plans for high-risk patient populations.
• Coordinated medical, behavioral health, social service, and community resources to support patient health goals.
• Managed transitional care services for patients following hospitalization, ensuring medication reconciliation and follow-up appointments.
• Collaborated with providers to address care gaps, improve quality outcomes, and support value-based reimbursement initiatives.
• Educated patients and caregivers regarding chronic disease management, treatment adherence, and available community services.
• Documented care interventions and outcomes within electronic medical record systems while maintaining regulatory compliance.

Education

Bachelor of Science in Nursing (BSN) University Name | City, State

Licensure & Certifications

• Registered Nurse (RN), State of ______
• Case Management Certification (CCM), if applicable
• Basic Life Support (BLS)
• Additional certifications as applicable

Key Accomplishments

• Led multidisciplinary care management teams serving complex patient populations.
• Improved quality measure performance and care gap closure rates.
• Reduced unnecessary hospital and emergency department utilization through targeted case management strategies.
• Enhanced patient engagement, continuity of care, and provider collaboration.
• Successfully implemented value-based care initiatives aligned with organizational financial and quality objectives.

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