Case Manager

Job Title: Case Manager I/II/Sr.

Job Number: 

Unit: All lines of business

Date Originated:    1/2016

Work Location:  Community Based/Clinic

Revision Date:    08/17/2023

Reports to: Supervisor of Case Management 

EEOC Category  

Worker’s Comp Code     8810

☒Full-time

☐Part-time

☐On-Call

☒ Exempt

Location: 

Discipline of Scope: 

Hours: 

Overview of Duties and Responsibilities:

Driving/Travel Requirements

Annual Training

Additional Trainings and credentialing may be required

Supervisory Responsibilities:

☒   None

☐   Oversees: 

Education, Licensure and Experience Requirements:

Required Qualifications:

• A bachelor’s degree in a Human Services Field 

• 2 or more years of community based in mental health as a case manager, or community psych nurse

• 1+ years of recent experience with a mental health/behavioral health clinical experience

• Roles that are interfacing with our children, adolescent, and teen population will require a total of 3 years working with minors or 24 hours of child-specific training (CEUs) to be certified by CMHP for MDHHS qualified provider.

• Excellent typing skills and ability to navigate a Windows based environment, experience in the use and navigation of an electronic medical record (EMR)

• Ability to navigate through an electronic medical record (EMR) and utilize Microsoft Products such as Outlook, Teams, Word, and Excel.

• Access to secure, high-speed internet and a dedicated, ability to work remote or within a hybrid role, with ability to protect health information and maintain HIPAA

• New Graduates in Social work are welcome. Limited Licensures candidates, candidates will need to be eligible to sit for licensure and pass within 24 months of employment social work, or a minimum of (5) eligible limited licensure renewals.

Preferred Qualifications:  

• Limited Licensed Social Worker (LLBSW or LLMSW), Licensed Social Worker (LBSW or LMSW), or unrestricted Registered Nurse license in the state of Michigan

• Certified Case Manager (CCM) OR the ability to obtain certification within 24 months of employment

• Background in community-based care, mental health, behavioral health, homecare, or managed care case management

• Experience/ knowledge of discharge planning, resolving disparities in health care, urban populations, atypical home settings, and court ordered mental health care

• Experience in utilization review, concurrent review, or coding

• Experience in removing gaps in care, barriers or/ other disparities in healthcare

Essential Job Duties

• Completes case management workflow per identified process and documents timely within the electronic medical record within policy identified timeframes. 

• Assesses referrals to identify patient/significant others’ needs, level of intensity, insurance benefits and other patient resources.

• Make in-person face -to-face encounters (visits) in the clients home, office, or virtual calls to assess members current health status and engage client

• Completes all documentation including required assessments, case plans or IPOS, within required time frames, per policy and procedure. 

• Collaborates with appropriate key individuals to participate in the case plan or IPOS process and continues to involve and communicate as needed to ensure best possible outcomes for client. 

• Identifies gaps or barriers in the case plan or IPOS treatment plans 

• Initiates patient focused case plan or IPOS, coordinating services, appointments and care within required time frames and as needed

• Make appropriate client centered referrals to outside sources as needed to resolve barriers to access, social determinants of health or benefits

• Assesses the educational needs of clients, families and members of the health care team and provides, develops and implements appropriate teaching strategies or makes appropriate referrals.

• Provides client education to assist with self-management as needed based on case plan or IPOS; and delivers clinical support to members across a wide array of health topics and conditions

• Provides ongoing monitoring of clients progress toward treatment goals and objectives via ongoing face to face contact as directed by the Person-Centered Plan of Service

• Promotes high-quality care through adherence to quality standards for documentation, case management process and client satisfaction

• Collaborates with specialists, physicians, and medical/clinical directors (for both physical, behavioral health and substance abuse) to coordinate inter-disciplinary care team, and attends any necessary on or off-site meetings to ensure patients care is seamless

• Reviews reporting for trends and data in compliance, medication adherence, outreach failures, er utilization, and/ but not limited to inpatient admissions, and provides ongoing monitoring of client

• Ensures client is compliant with treatment plan, provider visits and medication regimen; fosters and promotes self-care management and independence in the client’s care.

• Facilitates and supports client compliance with appointments with provider, clinic, and therapist interactions as needed 

• Maintains updates and contact with client following inpatient admission and/or ER visit to reduce risk for readmission and further ER utilization

• Maintain compliance with all company policies and procedures and applicable rules and regulations of MDHHS, DWHIN, NSO, and any other entity NSO has entered into a partnership or contracted agreement

• Coordinate with clients to ensure the correct identified resources are recommended or obtained within the client’s qualifying benefits or entitlement services

• Consults when appropriate to ensure adequate client caseloads

The following responsibilities and/or criteria are specific to the area of service line.

Community Case Manager – Adult Services operates within the community within the WellBeing line of service as detailed above in general role and responsibilities, plus those learned in precepting pertaining to workflow process related to SMI/Adult/Case Management/Complex Case Management/SUD populations.

Community Case Manager – Life Choices/SC operates within the community within the WellBeing line of service as detailed above in general role and responsibilities plus those learned in precepting pertaining to workflow process for children/IDD and Adult/IDD population.

Clinic Case Manager – Integrated Health operates within the ambulatory psychiatric care clinic within the Integrated Health line of service and encompass all the responsibilities as detailed within the general CM Sr role including the following duties that apply specifically to clinic based Clinical Practice and Quality of Care:

• Provides care that is safe, ethical, patient- and family-centered, culturally congruent, and evidence-based.
• Assesses and systemically collects any data related to patient health status and works in collaboration with the care team to develop the plan of care.
• Executes nursing interventions by collaborating with the interprofessional team incorporating appropriate standards of care and practice and patient outcomes for individuals with Intellectual or Developmental Disabilities (I/DD), Severely Mentally Ill (SMI) populations, other medical comorbid conditions.
• Performs and complete accurate and timely documentation in the electronic medical record of nursing assessment and interventions to reflect comprehensive and integrated approach to patient care.
• Telephone, use of electronic medical record and in-person triage (for symptom management)
• Manages a caseload of Integrated Health clients
• Complete comprehensive physical assessment, vital signs, venipuncture, glucose monitoring 
• Complete after discharge follow up calls (ADT Calls) and may complete additional assessments as needed for Social Determinants of Health, stratification of acuity, medical or psychiatric needs
• Secure Prior Authorizations for clinic services as necessary from commercial, Medicaid or Medicare managed care organizations
• Review and act on test results (e.g., labs)
• Review and manage communications from internal and external “Clients.”
• Provide patient education.
• Execute delegation protocols as appropriate to medical assistants or non-clinical staff.
• Assist with medication reconciliation, management, and refills.
• Assist with management of urgent and emergent patient care situations.
• Assist with the coordination of care across the continuum (e.g., inpatient, outpatient, home, skilled nursing facility, schools).
• Assist with the management of patients with multiple chronic health conditions, acute episodes of care, behavioral health.
• May float to other clinic locations as needed for operations need.
• May require on call duties
• All other duties as assigned

Classification of Case Management Roles & Stratification 

Case Manager I, incorporates all the identified responsibilities above and the following:

• At minimum holds a bachelor’s degree in applicable field of psychology, nursing, or social work.
• 2 years of more of mental health experience
• 1-2 years as a case manager in a related field  (3 years for those applying to work with minors)

Case Manager II, incorporates all the identified responsibilities above and the following:

• Currently has a certification in case management (CCM) or eligible to obtain within 12 months of employment.
• Social Work certification in SUD, Children’s

Case Manager Sr. incorporates all the identified responsibilities above and the following:

• Acts as subject matter expert in assigned area.
• Participates on committees as assigned.
• Acts as the subject matter expert for case management and assist with training and precepting for all newly hire staff for designated service line.
• 5 years of more of Mental health experience
• 5 or more years as a case manager
• May hold a master’s degree of Higher in related field of psychology, counseling, social work, nursing, public health, or health administration.