What Does a Case Manager Do?
A case manager coordinates a patient’s or client’s care across providers, payers, and community services so the person gets what they need and the organization controls cost and length of stay. Case managers work in hospitals and health systems, managed care and insurance companies, and social services and behavioral health agencies. They assess needs, build a care plan, arrange services, and document every step. Most employers require an RN license or a degree in social work plus 2 or more years of clinical or community experience.
The title covers 3 different jobs, and a posting should say which one it is. In a hospital, the case manager is usually an RN or a social worker who handles discharge planning and utilization review from the floor. At a managed care plan, the case manager works by phone, reviews authorization requests, and follows members with chronic conditions. In social services and behavioral health, a community case manager helps clients with housing, benefits, and treatment, often in the field. A utilization management support coordinator does the clerical side of authorizations without a license, an intake specialist opens the case but does not manage it, and a patient access representative handles registration and insurance verification. A bedside registered nurse delivers care; the RN case manager coordinates it.
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Hiring a Case Manager: What to Expect
Hospital case manager candidates come from med-surg and ICU nursing and from hospital social work departments; managed care candidates come from hospital case management and other health plans; community case managers come from social work programs and behavioral health agencies. In every setting, screen for the caseload size the candidate handled, which systems they documented in, and whether they have used InterQual or MCG criteria. Ask the candidate to walk you through a discharge they arranged when the family, the physician, and the payer disagreed; the ability to hold that conversation separates a case manager from a discharge clerk.
A frequent problem in case manager postings is asking for an RN and an MSW in the same requirement line, with a CCM on top, for a role that pays at the social work rate. Decide whether the position needs the clinical judgment of a nurse, the community and family skills of a social worker, or either, and state the license you will accept. Name the setting, the caseload, and whether the work is on site or telephonic.
A posting for this role should state how the day splits between discharge planning and utilization review, which criteria set the team uses, and how much of the work is peer-to-peer appeals and payer portal submissions. Candidates who expect discharge planning alone often leave within 90 days when the utilization workload appears.
On healthcare searches, 4 Corner Resources submits qualified candidates in an average of 4.5 days, clients interview an average of 1.46 candidates per hire, and we submit 1.85 candidates per hire.
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Case Manager Core Responsibilities
- Complete an initial assessment of each patient or client within the required timeframe, and document it in the electronic record
- Develop an individualized care or service plan with measurable goals, and update it as the person’s condition changes
- Coordinate discharge plans with physicians, nursing, therapy, and the family, including placement in skilled nursing, rehab, home health, or hospice
- Apply InterQual or MCG criteria to admission and continued-stay reviews, and escalate cases that do not meet criteria to the physician advisor
- Review length of stay and observation status daily, and act on patients at risk of an avoidable day
- Submit and track prior authorization requests through payer portals, and prepare peer-to-peer appeals when a request is denied
- Connect clients to community resources such as housing, transportation, Medicaid, and disability benefits, and confirm each referral went through
- Monitor members or clients with chronic conditions through scheduled contacts, and intervene when readmission risk rises
- Review readmission risk scores and AI-generated chart summaries in the EHR or care management platform, and confirm them against the record before acting
- Maintain documentation that meets CMS Conditions of Participation, NCQA, or state agency standards
- Track avoidable days, readmissions, or length of stay for the caseload, and report them to the department manager
Required Skills and Qualifications
Hard skills
- Active RN license, or a bachelor’s or master’s degree in social work with the license the state requires for the setting
- Working knowledge of Medicare, Medicaid, and commercial payer rules for admissions, authorizations, and post-acute benefits
- Familiarity with CMS prior authorization decision timeframes and payer portal submissions
- Experience with InterQual or MCG criteria for hospital and managed care roles
- Proficiency in Epic or Oracle Health, or in a payer case management platform such as TruCare or Jiva
- Knowledge of post-acute options, including skilled nursing, inpatient rehab, home health, and hospice
- Ability to manage 20 to 30 hospital patients or 60 or more telephonic members and meet documentation deadlines
- Understanding of HIPAA and of the consent rules for behavioral health and substance use records (42 CFR Part 2)
Soft skills
- Negotiation with physicians, families, and payer reviewers who want different outcomes
- Calm under pressure when a discharge falls apart at 4 p.m. on a Friday
- Documentation an auditor can follow without a verbal explanation
- Persistence with clients who miss appointments or disengage from treatment
- Independent judgment in the field or on the phone without a supervisor in the room
Education
- Associate or bachelor’s degree in nursing for RN case managers; bachelor’s or master’s degree in social work for social work case managers
- Bachelor’s degree in psychology, counseling, or human services for many community roles
Certifications
- Active RN license or social work license (LCSW, LMSW, or the state equivalent) as the role requires
- Certified Case Manager (CCM) or Accredited Case Manager (ACM) preferred for hospital and managed care roles, and often required within 2 years of hire
- A state workers’ compensation case manager credential for disability and workers’ comp roles
Preferred Qualifications
- 2 or more years of case management experience in the same setting as the opening
- Direct experience with the employer’s EHR or payer platform
- Experience with value-based care programs or readmission reduction initiatives
- Experience with AI documentation or risk stratification tools in the EHR or care management platform
- Bilingual in English and Spanish, or another language common in the patient population
How Much Does a Case Manager Make?
Typical national range: $37,410 to $58,715, with a national average of $44,675. Salary data reviewed October 2026 by 4 Corner Resources.
Case manager salaries vary by experience, industry, organization size, and geography. Click below to explore salaries by local market.
The average national salary for a Case Manager is:
$44,675
Sample Job Description Templates for Case Managers
RN Case Manager (Hospital)
Position Overview
We are hiring an RN Case Manager for our acute care hospital. You will manage discharge planning and utilization review for an assigned unit, work with physicians, nursing, therapy, and families to move patients to the right next level of care, and keep each admission within payer criteria. The position reports to the Director of Case Management.
Responsibilities
- Complete an initial assessment within 24 hours of admission and build a discharge plan with the patient and family
- Conduct admission and continued-stay reviews against InterQual criteria and refer non-qualifying cases to the physician advisor
- Submit authorizations through payer portals and prepare peer-to-peer appeals for denied days
- Arrange placements in skilled nursing, rehab, home health, or hospice, and confirm authorization before transfer
- Lead the unit’s daily interdisciplinary rounds and document barriers to discharge
- Track avoidable days and readmissions for the unit and report them weekly
- Deliver the Medicare Outpatient Observation Notice (MOON) and the Important Message from Medicare to patients on time
Requirements
Hard skills
- Active RN license in this state and 3 or more years of acute care nursing experience
- 1 or more years of hospital case management or utilization review experience
- Working knowledge of Medicare and Medicaid rules for admission status and post-acute benefits
- Experience documenting in Epic
Soft skills
- Able to hold a hard conversation with a family about a placement they did not want
- Keeps 25 active cases moving at once
- Direct and respectful with physicians when criteria are not met
Education
- Associate degree in nursing required; bachelor’s degree in nursing preferred
Certifications
- CCM or ACM certification preferred, or obtained within 2 years of hire
Case Manager, Managed Care (Telephonic)
Position Overview
Our health plan is adding a Telephonic Case Manager to our care management team. You will work from home, follow a panel of members with complex or chronic conditions, coordinate their care with treating providers, and review authorization requests against medical necessity criteria. You will report to the Manager of Care Management.
Responsibilities
- Reach assigned members by phone within the program’s timeframe and complete a comprehensive assessment
- Build and update care plans in the case management platform and share them with the member’s primary care provider
- Review prior authorization requests against MCG criteria and route denials to the medical director
- Meet CMS prior authorization decision timeframes of 72 hours for expedited requests and 7 calendar days for standard requests
- Coordinate transitions of care after hospital discharge to reduce readmissions
- Document every contact to NCQA and state audit standards
- Correct AI-generated call summaries in the care management platform before saving them to the member record
- Educate members on their benefits, medications, and self-management goals
Requirements
Hard skills
- Active, unrestricted RN license with compact privileges, or a licensed social worker for the behavioral health panel
- 2 or more years of case management, utilization management, or home health experience
- Experience with MCG or InterQual and with a payer case management platform
- Comfortable with a remote, phone-based workday and a productivity standard
Soft skills
- Builds rapport by phone with members who did not ask for a call
- Self-directed in a remote role with measured output
- Clear with providers about what the plan will and will not authorize
Education
- Associate degree in nursing or bachelor’s degree in social work required; bachelor’s degree in nursing preferred
Certifications
- CCM certification preferred
Behavioral Health Case Manager (Community)
Position Overview
We are seeking a Community Case Manager for our behavioral health agency. You will work with adults living with serious mental illness or substance use disorders and help them keep housing, benefits, and treatment appointments, meeting them in shelters, clinics, and their homes. The role reports to the Clinical Program Manager.
Responsibilities
- Maintain a caseload of 25 to 35 clients and see each one at the frequency their service plan requires
- Complete psychosocial assessments and service plans within state and Medicaid timelines
- Help clients apply for Medicaid, SSI or SSDI, SNAP, and housing programs, and follow each application to a decision
- Coordinate with treatment providers, probation officers, and family members as the client consents
- Respond to crises during business hours and connect clients to mobile crisis or inpatient services
- Document services in the agency’s electronic record on a mobile device the same day to support Medicaid billing
Requirements
Hard skills
- Bachelor’s degree in social work, psychology, counseling, or a related human services field
- 1 or more years of experience with adults with serious mental illness, substance use disorders, or homelessness
- Working knowledge of Medicaid targeted case management rules and public benefit programs
- Valid driver’s license, reliable vehicle, and daily travel within the service area
Soft skills
- Patient with clients who disengage and re-engage over months
- Steady in homes and shelters where conditions are unpredictable
- Keeps boundaries while staying warm
Education
- Bachelor’s degree in a human services field required; master’s degree in social work or counseling preferred
Preferred qualifications
- Certified Psychiatric Rehabilitation Practitioner or a state behavioral health case management credential
Workers’ Compensation Nurse Case Manager
Position Overview
We are hiring a Workers’ Compensation Nurse Case Manager to coordinate medical care for injured workers and support their return to work. You will work with treating physicians, claims adjusters, employers, and the injured worker to keep treatment on track and appropriate to the injury. The position reports to the Case Management Supervisor.
Responsibilities
- Review medical records and treatment plans for assigned claims and confirm they match the compensable injury
- Attend physician appointments with injured workers, or coordinate them by phone, and report to the adjuster
- Develop return-to-work plans with the employer, including modified duty options
- Apply state treatment guidelines and the Official Disability Guidelines to recommend approvals or referrals for review
- Contact the injured worker at the frequency the file requires and document each contact
- Hold telehealth check-ins with injured workers when an in-person visit is not required
- Prepare case reports and cost-savings summaries for the carrier or employer
Requirements
Hard skills
- Active RN license in the states covered and 3 or more years of clinical experience in orthopedics, occupational health, or rehabilitation
- Knowledge of workers’ compensation rules in the assigned states
- Experience with the Official Disability Guidelines or state treatment guidelines
- Valid driver’s license and willingness to travel for field roles
Soft skills
- Even-handed with workers, employers, and adjusters who each want a different outcome
- Precise in written reports that may be read at a hearing
- Manages a caseload across several states without reminders
Education
- Associate degree in nursing required; bachelor’s degree in nursing preferred
Certifications
- CCM, CRRN, or COHN certification preferred; a state workers’ compensation case manager certification where the state mandates it