Case Management Manager

About the role

The Case Management Manager serves as a patient advocate and care coordinator for hospital clients, ensuring high‑quality, cost‑effective patient management and continuity of care. This role blends leadership with hands‑on case management to support complex patients throughout admission, treatment, and discharge.

Key responsibilities

• Coordinate, negotiate, and procure services and resources for complex patient cases.
• Apply medical necessity criteria, conduct InterQual® and EQ Health reviews, and manage utilization reviews.
• Oversee observation patient processes, bed assignments, and discharge planning.
• Generate statistical reports on avoidable admissions, denials, and physician advisor reviews.
• Collaborate with interdisciplinary staff, physicians, families, and legal representatives.
• Participate in quality improvement, risk management, and JCAHO compliance initiatives.
• Lead the case management team and may perform direct case management duties as needed.

Required profile

• Bachelor’s degree in a relevant field.
• Active State of Florida RN license.
• Minimum five years of hospital case/care management experience and at least one year of supervisory experience.
• Strong knowledge of patient assessment, medical terminology, and healthcare regulations.
• Professional appearance and effective English communication skills.

Required skills

• InterQual® utilization review system.
• EQ Health review tools.
• JCAHO standards and compliance.
• Quality improvement processes.
• Risk management practices.
• Computer proficiency for data reporting and documentation.