Case Manager III

Job description

Job Requirements
Schedule Details: 8am - 4:30pm Weekends Required
Provides advanced patient-centered care management while serving as a clinical and operational leader within the organization. Manages and consults on complex patient situations and serves as an expert resource for case management practice, regulatory requirements, and care coordination strategies. In addition to conducting advanced assessments and care planning, collaborates with organizational leaders, providers, and interdisciplinary teams to develop workflows, implement best practices, strengthen policies and procedures, and improve care delivery across the system. Supports quality improvement, evidence-based practice integration, and professional development, while providing consultation and guidance to case management staff and other departments.
Primary Responsibilities
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job responsibilities performed.
• Serve as the organization's expert resource for case management practice, care coordination, regulatory compliance, and patient transition strategies.
• Provide consultation and guidance on the most complex patient cases and system-level care coordination challenges.
• Lead the development, implementation, and evaluation of workflows, clinical practices, and care management processes.
• Collaborate with organizational leadership to develop and maintain policies, procedures, and operational guidelines supporting case management services.
• Monitor departmental practices and integrate evidence-based standards to advance quality, safety, and patient outcomes.
• Provide mentorship, consultation, and professional leadership to case management staff and interdisciplinary teams across the organization.
• Lead or support organizational quality improvement, regulatory readiness, accreditation, and population health initiatives.
• Foster collaboration among departments, providers, payers, and community organizations to improve service delivery and care continuity.
• Evaluate operational and clinical outcomes to identify opportunities for strategic improvement and innovation in care management practices.
• Represent the department through professional organization involvement, educational activities, committee leadership, or other practice advancement initiatives.
• Perform all other duties as assigned.

Work Experience
Education & Experience - Required
Provide the minimum required education that includes the discipline(s). Provide the minimum year(s) and type(s) of experience required (do not use a range). Provide required certifications and/or licensures.
• Bachelor of Science in Nursing or Master's degree in Physical Therapy.
• Current Maryland unrestricted licensure as a Registered Nurse (RN) or Physical Therapist (PT).
• Five (5) years of previous case management experience.
• Membership in a professional healthcare or case management organization.
• Demonstrated expertise in case management practice, regulatory requirements, utilization management, care transitions, and care coordination.
• Previous experience providing consultation on complex clinical and operational issues.
• Previous experience leading practice improvement, workflow development, policy implementation, or quality initiatives.

Education & Experience – Preferred
• Current specialty certification (CCM, ACM, CMAC, or equivalent).
• Additional graduate-level coursework, post-baccalaureate certificate, or advanced degree.
• Experience teaching, precepting, or developing educational programs.
• Leadership role within a professional association, hospital committee, or system-wide initiative.
• Experience conducting peer review, publishing, presenting, or contributing to evidence-based practice initiatives.
• Recognized subject matter expert in a specialty area of case management.

Knowledge, Skills, & Abilities
• Expert knowledge of case management practice, utilization management, and care transitions.
• Healthcare regulations, accreditation standards, and organizational policies.
• Evidence-based practice implementation and practice design.
• Healthcare operations, workflow development, and change management.
• Organizational consultation and strategic problem-solving.
• Policy and workflow development.
• Practice leadership and professional mentoring.
• Quality improvement leadership and outcome evaluation.
• Facilitation of system-wide interdisciplinary initiatives.
• Provide expert consultation on the most complex patient and operational issues.
• Influence organizational practices and care management strategy.
• Lead development of clinical guidelines, workflows, and standards.
• Mentor staff and develop departmental capabilities.
• Drive continuous improvement through evidence-based practice.