Case Manager

The Case Manager provides clinically focused care coordination and transition management services to support safe, efficient, and patient-centered care throughout hospitalization. This role partners with patients, families, physicians, social workers, payers, and interdisciplinary team members to facilitate timely progression of care, address barriers to discharge, and ensure successful transitions across the continuum of care.

The Case Manager develops, implements, and evaluates individualized discharge plans, coordinates post-acute services, communicates payer authorization determinations, and utilizes risk stratification tools to identify high-risk patients. The goal is to reduce delays in care, prevent avoidable readmissions, and promote optimal patient outcomes.

• Assess patients and families to identify transition-of-care needs and develop individualized discharge plans.
• Initiate discharge planning upon admission and actively manage plans throughout hospitalization.
• Evaluate patient risk scores and implement enhanced care coordination interventions for high-risk patients.
• Reassess discharge plans at least every eight (8) business days and whenever there is a significant change in condition or care needs.
• Communicate authorization approvals, denials, and payer determinations to the care team.
• Collaborate with physicians, nursing, social work, rehabilitation services, and other disciplines to address barriers to discharge.
• Monitor patient progress toward discharge goals and intervene when progression is delayed.
• Participate in and lead interdisciplinary rounds, care progression meetings, and complex case discussions.

• Partner with patients and families to develop patient-centered discharge plans.
• Educate patients and caregivers regarding post-acute care options and available community resources.
• Ensure Freedom of Choice documentation is completed for all applicable post-discharge services and placements.
• Support informed decision-making regarding discharge and service selection.

• Coordinate home health services, durable medical equipment (DME), infusion therapy, rehabilitation services, skilled nursing facility placement, and other post-discharge resources.
• Ensure discharge milestones are established, documented, and updated as needed.
• Facilitate referrals and transfer of clinical documentation to receiving providers and agencies prior to discharge.

• Identify high-risk patients through clinical assessment, risk scores, and interdisciplinary referrals.
• Develop and implement targeted interventions to address identified risks.
• Escalate barriers requiring physician, leadership, payer, or interdisciplinary intervention.

• Maintain compliance with departmental, hospital, and regulatory policies and procedures.
• Demonstrate professionalism, excellent customer service, and effective communication in all interactions.
• Participate in ongoing professional development through educational programs, literature review, workshops, and training opportunities.
• Integrate evidence-based practice and current clinical knowledge into decision-making.
• Perform other duties as assigned.

• Technical Diploma in Nursing.

• Active Pennsylvania Registered Nurse (RN) license.

• Minimum five (5) years of nursing or healthcare experience.
• Knowledge of managed care admission processes, including benefit verification and admission notifications.
• Strong understanding of care coordination, utilization management, and discharge planning principles.

• Excellent communication, organizational, and interpersonal skills.
• Ability to work independently and collaboratively within interdisciplinary teams.
• Strong problem-solving and critical thinking abilities.
• Proven ability to manage competing priorities and meet deadlines.
• Strong customer service orientation.
• Proficiency with Microsoft Office Suite, including Word and Excel.

• Bachelor's Degree in Nursing (BSN).

• Prior Case Management experience.
• Utilization Review experience.
• Hospital discharge planning experience.
• Home health or community-based care coordination experience.
• Pediatric healthcare experience or experience in a comparable acute care setting.

• Accredited Case Manager (ACM) Certification.
• Certified Case Manager (CCM) Certification.

About Equiliem

Equiliem believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.

Across the U.S., leading companies in healthcare, government, engineering, manufacturing, professional services, and energy rely on us for their workforce solutions. Our recruiting and HR services include contract and direct hire staffing, Payrolling/EOR, Independent Contractor Compliance, and Managed Services.

For almost 30 years, we've helped shape our industry. Today, we continue to research, ask questions, and continuously enhance the candidate journey and client experience.

Benefits

We offer a comprehensive benefits package to our employees, which includes:

• Medical Insurance
• Vision & Dental Insurance
• Life Insurance
• Matching 401(k)
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

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Equiliem is an equal opportunity employer. We do not discriminate or allow discrimination based on race, color, religion, creed, sex, age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Equiliem will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [emailprotected] or (732) 238-6050.