Case Manager Job Description Guide & Template

Use this case manager job description guide to copy a complete, compliant posting. Then tailor it by setting and seniority.

You’ll get:

• A paste-ready template.
• Plug-in modules for hospitals, managed care, behavioral health, home health/hospice, social services, and non-clinical niches.
• Caseload/KPI guidance.
• Pay-transparency language.
• Interview alignment.

What is a Case Manager? (1‑Sentence Definition)

A Case Manager assesses needs, creates and coordinates individualized care plans, connects people to services, and tracks outcomes to improve quality, safety, access, and cost across healthcare or social-service settings.

Copy-Ready Case Manager Job Description Template

Copy this block into your ATS and fill in the brackets. Then add the setting-specific modules below. Note: Align licensing/certification with state law and applicable accrediting requirements (HIPAA, CMS, Joint Commission/NCQA) to ensure compliant scope and supervision.

Job Summary

Use this short overview to frame purpose, population, and setting.

[Organization] seeks a Case Manager to assess needs, develop individualized care plans, coordinate services, and advocate for [patients/clients/members] in [hospital/managed care/behavioral health/home health/social services] settings. You will collaborate with an interdisciplinary team to improve quality, safety, experience, and appropriate utilization. This role balances direct client engagement with documentation and outcomes tracking.

Key Responsibilities

Pin responsibilities to core functions you will measure.

• Assessment: Conduct biopsychosocial/clinical assessments; identify risks, social determinants, and eligibility for programs.
• Planning: Develop person-centered care plans with measurable goals; update plans based on progress and acuity.
• Coordination: Arrange services (medical, behavioral, social), schedule appointments, and facilitate transitions of care.
• Advocacy: Educate clients/families on conditions, benefits, and community resources; reduce barriers to access.
• Utilization/Quality: Apply evidence-based criteria (e.g., InterQual/MCG) and align with CMS/NCQA/Joint Commission standards.
• Documentation: Complete timely, accurate notes, authorizations, and reports in the EMR/case management system.
• Outcomes: Track KPIs (e.g., readmissions, length of stay, HEDIS gaps, housing/benefit outcomes) and report trends.
• Collaboration: Participate in interdisciplinary rounds/case conferences; escalate complex cases; hand off effectively.
• Safety/Compliance: Maintain HIPAA confidentiality and ethical practice; follow organizational policies and regulatory requirements.
• Continuous Improvement: Identify process gaps and contribute to workflow enhancements.

Required Qualifications

State the minimums for safe practice in your setting.

• Education: [RN/LPN/LVN/LCSW/BSW/BA/BS in Health or Human Services] or equivalent as required by role and state law.
• Experience: [1–2+] years in [hospital care management/managed care/social services/behavioral health/home health].
• Knowledge: Care planning, community resources, and payer/utilization processes relevant to the setting.
• Technical: Proficiency with EMR/case management systems and Microsoft Office/Google Workspace.
• Compliance: Understanding of HIPAA and applicable accrediting/quality standards (e.g., CMS, Joint Commission, NCQA).
• Driver’s license/transportation if fieldwork/home visits are required.

Preferred Qualifications

Use this to differentiate senior talent without inflating minimums.

• 3–5+ years in case management or related specialty; prior outcomes/KPI ownership.
• Experience with [InterQual/MCG], HEDIS/quality programs, and transitions of care.
• Language skills relevant to your community; cultural humility and trauma-informed practice.
• Leadership: precepting, mentoring, or workflow improvement experience.
• Advanced degree (MSN, MSW, MHA, MPH) or specialty training (motivational interviewing, crisis intervention).

Certifications & Licensure

Specify required vs preferred based on setting and state.

• Required: Active, unencumbered [RN/LCSW/LMSW/LPC/LMHC] license in [State].
• Preferred: CCM (Commission for Case Manager Certification) or ACM (Accredited Case Manager, ACMA).
• Other (as applicable): BLS; state-specific credentials (e.g., social work registration); valid driver’s license for field roles.

Skills & Competencies

List soft and technical skills you will evaluate.

• Communication, empathy, and de-escalation; strong teaching and advocacy.
• Critical thinking, prioritization, and problem-solving under time pressure.
• Cultural humility and client-centered, trauma-informed approaches.
• Collaboration across disciplines and systems; negotiation and conflict resolution.
• Data literacy: documentation accuracy, basic analytics, and KPI awareness.
• Technology: EMR/case management platforms, payer portals, video visits/telehealth, and Excel/Sheets.

Work Environment & Schedule

Set expectations for location, hours, and flexibility.

• Work model: [On-site/Hybrid/Remote/Field-based] with approximately [0–60%] travel in [Region].
• Schedule: [Day/evening] shifts; [weekday/weekend] rotation; [on-call] as needed for transitions/crises.
• Physical/mental demands (with reasonable accommodation): prolonged computer use; ability to [lift 20 lbs/drive/visit home sites]; manage competing priorities.

Reporting Structure & Team

Clarify accountability and collaboration.

• Reports to: [Manager/Director of Case Management/Population Health/Social Services].
• Collaborates with: physicians, nurses, social workers, therapists, pharmacists, community partners, and payer representatives.
• For senior roles: may mentor peers, precept new hires, and lead projects or daily huddles.

Tools & Software

Name platforms to attract qualified applicants.

• EMR/EHR: [Epic, Oracle Health (Cerner), Meditech, NextGen, athenahealth].
• Case management/UM: [CarePort/WellSky, GuidingCare, Medecision, MCG CareWebQI, InterQual].
• Payer portals: [Availity, NaviNet] and state Medicaid portals.
• Productivity/analytics: Microsoft 365/Google Workspace; basic Excel/Sheets (filters, pivot tables, v-lookups preferred).
• Communication: secure messaging, telehealth/video platforms.

Compensation & Benefits

Use transparent, compliant pay language tied to market and parity.

• Pay range (salary/hourly): [$X–$Y], based on experience, education/licensure, internal equity, and market data (BLS + local surveys).
• Differentials/bonuses: [shift/evening/weekend], on-call stipends, performance bonus eligibility.
• Benefits: medical/dental/vision, retirement match, paid time off, CEU/tuition support, licensure reimbursement, mileage for field roles.
• FLSA status: [Exempt/Non-exempt]; overtime eligibility per policy and law.
• Note: Range reflects the good-faith pay estimate for [location] and may vary with geography.

EEO & Inclusive Language

Demonstrate compliance and inclusion.

• [Organization] is an Equal Opportunity Employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or other protected status.
• We provide reasonable accommodations to qualified individuals with disabilities. To request accommodation, contact [email/contact method].
• Job duties may be modified to support accessibility and essential functions.

How to Apply

Close with clear steps.

• Apply at: [URL] and include your resume/CV and a brief note on relevant case management experience.
• Optional: attach licensure/certifications (RN/LCSW/CCM/ACM) and a sample of de-identified documentation or outcomes summary.
• Application window closes on: [Date]. Selected candidates will be contacted for a [phone/video] interview.

Customize by Setting: Plug‑in Modules

Use these add-ons to tailor responsibilities and requirements to your environment. Add only the bullets that fit your scope and licensure rules. This helps candidates self-assess quickly and keeps your posting aligned with accreditation.

Hospital/Acute Care

• Lead discharge planning; complete initial assessment within 24 hours of admission.
• Conduct daily interdisciplinary rounds; remove barriers to timely, safe discharge.
• Perform utilization review using InterQual/MCG; collaborate with physician advisors.
• Coordinate post-acute placements (SNF, home health, rehab) and DME.
• Track readmissions, avoidable days, and length of stay vs. expected.

Managed Care/Insurance

• Manage a panel of members for condition management and complex case management.
• Close HEDIS/Stars gaps; execute 7- and 30‑day post-discharge outreach.
• Process prior authorizations and concurrent review within turnaround-time standards.
• Navigate payer portals and analytics to identify high-risk members and trends.
• Educate providers and members on benefits, network, and appeals/grievances.

Behavioral/Mental Health

• Complete biopsychosocial assessments, safety/crisis plans, and risk stratification.
• Coordinate therapy, psychiatry, substance use treatment, and community supports.
• Facilitate warm handoffs after ED/psychiatric hospitalization; track 7/30‑day follow-ups.
• Apply trauma-informed and culturally responsive care; de-escalate crises.
• Document symptom scales (e.g., PHQ‑9, GAD‑7) and engagement metrics.

Home Health/Hospice

• Conduct home visits; assess safety, caregiver needs, and social determinants.
• Coordinate IDG/IDT care conferences; educate families on symptom management.
• Complete OASIS/hospice documentation within required timeframes.
• Manage visit schedules, after-hours triage/on-call rotation, and DME coordination.
• Track pain/symptom control, avoidable hospitalizations, and CAHPS experience.

Social Services/Community

• Navigate benefits (Medicaid/Medicare, SNAP, SSI/SSDI), housing, and transportation.
• Build partnerships with shelters, food programs, legal aid, and workforce services.
• Support reentry and stabilization; monitor program participation and goal attainment.
• Conduct fieldwork/community site visits with safety protocols.
• Measure outcomes: benefit approvals, housing placements, employment retention.

Legal/Refugee/Corrections/Schools

• Legal case management: court filings, deadlines, client communication, and evidence tracking.
• Refugee resettlement: housing setup, medical screenings, ESL/workforce referrals.
• Corrections/reentry: pre-release planning, supervision coordination, and community reintegration.
• Schools: align services with IEP/504 plans and coordinate with counselors/therapists.
• Tools: legal platforms (e.g., Clio/MyCase) or education systems (e.g., IEP management).

Entry-Level vs Senior/Lead Case Manager: Duties and Requirements

Use this to right-size scope and pay. Entry-level roles focus on a defined caseload, standard workflows, and learning quality/utilization metrics. Senior/Lead roles handle the most complex cases, mentor peers, optimize processes, and own KPI targets and cross-functional initiatives.

• Entry-level: 0–2 years, works from established pathways; escalates barriers; contributes to daily huddles; may not require specialty certification at hire.
• Mid/Senior: 3–5+ years, manages high-acuity caseload; leads rounds/projects; trains staff; preferred CCM/ACM; demonstrates measurable outcomes.
• Lead/Supervisor: sets daily throughput targets, manages staffing/caseload balance, partners with medical directors, and reports KPI trends to leadership.
• To avoid grade compression, keep minimums stable and differentiate by complexity, autonomy, project/mentorship scope, and KPI ownership.

Case Manager vs Care Coordinator vs Social Worker

Pick the title that matches your need and compliance requirements. Case Managers own assessment, plan-of-care, coordination, utilization/quality alignment, and outcome tracking. They may require RN or LCSW based on setting and scope. Care Coordinators handle logistics, reminders, referrals, and basic navigation under licensed oversight. Social Workers provide psychosocial assessment, counseling/therapy (if licensed), resource linkage, and advocacy.

• Choose RN Case Manager when medical assessment, utilization review, and clinical decision support are core (hospital/managed care/home health).
• Choose LCSW Case Manager when therapy/counseling or complex psychosocial intervention is central (behavioral health, palliative, community).
• Choose bachelor’s-level Case Manager/Care Coordinator for navigation, benefits, and non-clinical support under licensed supervision.
• If most duties are scheduling and referrals without plan-of-care ownership, post as Care Coordinator to align pay banding and expectations.

Caseload and KPIs: What to Include (Safely) in Your JD

Use these ranges and metrics as starting points. Validate them against your acuity model and policy to avoid overpromising. Phrase caseloads as “typical ranges adjusted for acuity, staffing, and census.”

• Prudent caseload ranges (example language):
• Hospital/Acute RN Case Manager: “Typically supports 12–22 patients/day, adjusted for unit acuity and throughput.”
• Managed Care: “Active panel generally 75–150 members, balanced by risk tier and engagement.”
• Behavioral Health: “Active caseload usually 25–45 clients, scaled by acuity and crisis activity.”
• Home Health/Hospice: “Typical active census 15–25 patients, adjusted for geography and visit intensity.”
• Social Services/Community: “Generally 20–40 clients, varying with program requirements.”
• KPIs to include by setting:
• Hospital: initial assessment ≤24 hours; length of stay vs expected; 30‑day readmissions; avoidable days; discharge by target date.
• Managed Care: HEDIS gap closure; 7/30‑day post-discharge outreach; prior auth TAT; ER visits/1000; care plan completion within 30 days.
• Behavioral Health: 7/30‑day follow-up after hospitalization; no-show rate; PHQ‑9/GAD‑7 improvement; crisis plan completion.
• Home Health/Hospice: OASIS timeliness; visit adherence; hospitalization avoidance; CAHPS; symptom control metrics.
• Social Services: benefit approval rate; time-to-housing; retention in services; court compliance milestones.

Add this line to your JD if you track performance:

“Performance is measured using role-appropriate KPIs with support for continuous improvement.”

Salary and Scheduling: How to Write Transparent, Compliant Language

Use a clear method: cite market data (BLS + reputable local surveys/aggregators), internal parity, and geographic differentials. State FLSA status, overtime eligibility, and differentials without guaranteeing hours or specific caseloads.

• Example pay statement: “The good-faith pay range for this position is $72,000–$92,000 annually, based on experience, education/licensure, internal equity, and local market data. This role is [exempt/non-exempt]. Evening/weekend differentials may apply.”
• Scheduling: define typical hours, on-call rotation, and weekend expectations without implying fixed volumes.
• Field/remote: specify hybrid/remote eligibility, required residency/location, equipment provided, and travel percentage.
• Bonuses: describe eligibility and the nature of at-risk pay (e.g., quality or productivity incentives) without tying to a guaranteed metric.

Compliance You Should Reference

Name the standards that govern your setting for credibility and clarity.

• HIPAA: privacy and security of protected health information.
• CMS Conditions of Participation and Medicare Advantage rules (if applicable).
• The Joint Commission or DNV (hospitals) and NCQA (managed care) accreditation standards.
• State licensure laws: nursing, social work, counseling; scope-of-practice requirements.
• Evidence-based utilization criteria: InterQual or MCG.
• Documentation retention and consent requirements per state/federal policy.

Add this line to your JD if you operate under accreditation:

“Practices align with [Joint Commission/NCQA/State] standards and internal policies.”

Interview Alignment: Screening Questions and Red Flags

Use these prompts to test for competency tied to your JD.

• Screening questions:
• Walk me through your assessment-to-discharge (or plan-to-outcome) process for a complex case.
• How have you used InterQual/MCG (or HEDIS/Stars) to drive decisions and outcomes?
• Describe how you prioritize a full caseload when two high-acuity issues arise at once.
• What documentation turnaround standards have you met (e.g., initial assessment, progress notes)?
• Tell me about a time you removed a barrier to care involving benefits, transportation, or housing.
• Which case management tools/EMRs and payer portals have you used, and to what level?
• Red flags:
• Vague about outcomes, KPIs, or documentation timeliness.
• Limited understanding of HIPAA, utilization criteria, or accreditation standards.
• Blames other departments without examples of collaboration or escalation.
• Discomfort with data/technology or resistance to standard workflows.
• Boundary issues or poor articulation of client-centered, culturally responsive care.

Quick FAQs

Use these quick answers to align your posting with best practices and candidate expectations.

• How to write a case manager job description?
  Start with a clear job summary. List core duties (assessment, planning, coordination, documentation, compliance). Define minimum qualifications/licensure. Add setting-specific modules, KPIs, caseload ranges with disclaimers, pay transparency, and EEO/ADA language.
• What does a Case Manager do?
  They assess needs, create and coordinate care plans, connect clients to services, and track outcomes to improve quality, access, and cost.
• Is a Case Manager an RN or a Social Worker?
  Either. Choose RN for clinical/utilization-intensive roles (hospital, managed care, home health). Choose LCSW for psychosocial/therapy-focused roles (behavioral health, palliative, community). Bachelor’s-level roles fit coordination under licensed oversight.
• What qualifications are typical?
  RN or LCSW/LMSW for clinical/behavioral roles. BA/BS in health or human services for coordination. CCM/ACM preferred. Experience aligned to setting.
• Remote case manager job description tips?
  Specify eligible states and work hours/time zones. Note secure tech requirements and travel for occasional on-sites. Include productivity/KPI expectations.
• Which software should I list?
  EMR (Epic/Oracle Health/Meditech), case management/UM (CarePort/WellSky, Medecision, GuidingCare, InterQual/MCG), payer portals (Availity/NaviNet), and productivity tools (Excel/Sheets).

Related Role Templates and Next Steps

If you’re refining scope, consider adjacent templates:

• Care Coordinator
• RN Utilization Review Nurse
• Social Worker (LCSW)
• Discharge Planner
• Population Health Nurse
• Behavioral Health Case Manager
• Home Health RN
• Medical Social Worker
• Legal Case Manager
• Patient Navigator

Next, finalize your setting modules and insert compliant pay and EEO/ADA language. Align KPIs to leadership goals, and publish to channels that reach RN/LCSW and community-services talent.