The Care Manager is accountable for outcomes as related to providing coordination of patient management through the continuum of care. Responsible for financial, clinical, and discharge planning evaluation for each assigned patient. Assures payment for services rendered, coordinates care, manages resources, and facilitates each patient encounter for efficient and effective outcomes as related to quality, clinical and cost areas.

Outcomes Case Manager Job Description Position Title Outcomes Case Manager Position Summary The Outcomes Case Manager is responsible for coordinating patient care, managing transitions across the continuum of care, and improving clinical, quality, and financial outcomes. This role collaborates with physicians, nurses, interdisciplinary teams, patients, families, and community resources to ensure appropriate care progression, timely discharge planning, reduced readmissions, and achievement of organizational quality metrics. Essential Duties and Responsibilities Care Coordination Conduct comprehensive assessments of patients' medical, psychosocial, and discharge planning needs. Develop and implement individualized care plans in collaboration with the interdisciplinary team. Coordinate services and resources to facilitate safe, effective, and timely transitions of care. Monitor patient progress and adjust care plans as needed. Advocate for patients and families to ensure access to appropriate services and support. Outcomes Management Track and evaluate patient outcomes, including length of stay, readmissions, avoidable days, and patient satisfaction measures. Identify barriers to achieving desired outcomes and implement interventions to address them. Utilize evidence-based practices to improve patient outcomes and quality of care. Participate in performance improvement initiatives and quality projects. Collaborate with leadership and clinical teams to improve organizational performance metrics. Discharge Planning Initiate discharge planning upon admission and coordinate ongoing planning throughout the hospitalization. Collaborate with patients, families, providers, and post-acute care agencies to ensure safe discharge arrangements. Educate patients and caregivers regarding treatment plans, medications, follow-up appointments, and available community resources. Ensure continuity of care through effective communication and handoffs. Facilitate referrals to community resources, home health, rehabilitation, long-term care, and other post-acute services as appropriate. Data Analysis and Reporting Review and analyze clinical and operational data to identify trends and opportunities for improvement. Maintain accurate and timely documentation in the electronic health record. Assist leadership with monitoring key performance indicators and outcome measures. Prepare reports related to quality, patient flow, and patient outcomes as requested. Support initiatives aimed at reducing readmissions and improving care transitions. Regulatory Compliance Maintain compliance with CMS, Joint Commission, state, federal, and organizational requirements. Adhere to confidentiality and HIPAA regulations. Participate in audits and accreditation activities as required. Ensure documentation supports organizational quality and compliance standards. Qualifications Education Registered Nurse (RN), Social Worker (MSW/BSW), or other healthcare professional with appropriate licensure. Bachelor's degree required; Master's degree preferred. Experience Minimum of 2–3 years of case management, care coordination, discharge planning, or related healthcare experience. Experience in acute care, population health, care coordination, or value-based care preferred. Certifications Certified Case Manager (CCM) preferred. ACM, ACM-RN, ACM-SW, or other relevant certification preferred. Knowledge, Skills, and Abilities Knowledge of case management principles, care coordination, discharge planning, and transitions of care. Strong understanding of healthcare regulations and quality improvement methodologies. Excellent communication, critical thinking, and problem-solving skills. Ability to analyze data and identify outcome improvement opportunities. Strong organizational and time-management skills. Proficiency with electronic health records and Microsoft Office applications. Performance Indicators Reduced hospital readmission rates. Improved patient satisfaction scores. Decreased avoidable days and length of stay. Timely completion of assessments and discharge plans. Compliance with regulatory and documentation standards. Achievement of quality and patient outcome targets. Reporting Relationship Reports to the Director of Case Management or designated leadership position. Work Environment Primarily based in a hospital, healthcare facility, or care management setting with regular interaction with patients, families, clinicians, community partners, and post-acute care providers.

• Manages an assigned caseload of patients from preadmission to discharge.
• Assumes responsibility for admission appropriateness (medical necessity), (outpatient, observation, inpatient admission), continued stay, and medical record monitoring
• Coordinates communication with third party payers, external review agencies and the Utilization Committee.
• Identify managed care issues and address promptly as related to denials management
• Coordinates and collaborate with physicians, provider, multidisciplinary team and other health care professionals concerning patient’s goals, plan of care and progress.
• Revise and adjust on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.
• Leads discharge planning multidisciplinary team meetings, ensures documentation of meetings
• Advocate for the patient/family and is knowledgeable of and act in accordance with legal principles of consent, healthcare proxies (power of attorney for healthcare) and advance medical directives.
• Stays abreast of developments in the case management field and seeks ongoing education to enhance practice skills. Care Management is willing to seek certification in case management field if made available through ARH.
• Stays abreast of regulatory agency guidelines as pertains to area of practice
• Initiate and monitor clinical care guidelines and analyze positive and negative variances
• Ensure continuity of care through formulation of discharge plan on admission and follow though until patient is discharged.
• Ensure appropriate use of resources.
• Monitor patient care for appropriate use of resources.
• Monitors length of stay on a concurrent, weekly, and monthly basis. Ensures that length of stay is appropriate based on medical necessity. Works with medical staff, hospital staff, and others to overcome barriers to discharge.
• Monitors in-house denials for extended lengths of stay.
• Participates in the denials management process to help ensure establishment of and adherence to processes that will minimize denials by third-party payers.
• Participates as a member of the Utilization Committee
• Assists in the collection of data to trend and analyze outcomes for identification of improvement opportunities.
• Participates in data collection, specific to outcomes data.
• Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.
• Performs other related duties as assigned.

• Associate's Degree Registered Nurse (licensed in state of employment) from an accredited school for nursing Preferred
• Bachelor's Degree Nurisng; Must be obtained within 5 years Preferred
• 4-6 years 5 Years of nursing experience may be considered with demonstration of skills required for the position.  Preferred
• Advanced knowledge of problem solving and decision making skills.
• Strong multi-tasking abilities with the ability to handle competing deadlines; flexible and adaptable.
• Ability to deal tactfully with customers and community.
• Advanced communication skills used to lead a team.
• Advanced execution and delivery (planning, delivering, and supporting) skills.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate one.
• Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
• Mastery knowledge of phases of care transitions and resources available for patients.
• Mastery of digital literacy skills.
• Ability to handle sensitive information ethically and responsibly.
• RN Preferred
• LPN Required