Case Manager

Job Description

Job Description

Position Summary

Responsible for leading, developing, and overseeing the quality, safety, and performance improvement programs under the leadership and guidance of the Chief Medical Officer. This role ensures high-quality, patient-centered care for elderly and medically complex populations across post-acute, long-term care, assisted living, and community-based settings. The case manager will partner with physicians, advanced practice providers, clinical leadership, and operations to drive measurable improvements in clinical outcomes, patient safety, and value-based care performance. The position plays a critical role in reducing avoidable hospitalizations, improving care transitions, and optimizing performance under ACO, Medicare Advantage, and other risk-based arrangements.

Key Responsibilities

1. Quality & Performance Improvement

• Under the leadership and guidance of the Chief Medical Officer, develop and monitor quality metrics aligned with geriatric best practices, regulatory requirements, and value-based care contracts
• Analyze quality data, identify trends, and implement corrective action plans
• Drive reduction in avoidable hospitalizations, readmissions, and adverse events

1. Clinical /Operational & Physician Engagement

• Interdisciplinary risk stratification rounds focused on patients at high risk for acute care readmission and social complexity
• Targeted care review sessions for patients with elevated clinical and social risk factors
• Multidisciplinary case review rounds addressing readmission risk and social determinants of health (Medical Directors, APPs, Case Managers, Facility staff)

III. Value-Based Care & Population Health

• Support quality performance for ACOs, MA plans, bundled payments, and other value-based arrangements

1. Education & Culture of Quality

• Educate clinicians and staff on quality standards, documentation requirements, and best practices in geriatric care
• Foster a culture of continuous improvement, accountability, and patient-centered care

Qualifications:

• 3-5 years of clinical experience in the post acute setting
• 3 years of case management experience preferred
• Current RN in the state of Texas OR Certification in Clinical Case Management (CCM) preferred
• Familiarity with electronic health records (EHR) and billing software
• Strong attention to detail and organizational skills
• Ability to handle confidential information in accordance with HIPAA regulations
• Proficiency with Microsoft Office (Word, Excel, Outlook)
• Excellent communication skills and a strong customer service orientation
• Ability to prioritize and manage multiple tasks with minimal supervision

Benefits:

• Competitive compensation
• Health, dental, and vision insurance
• Paid time off and paid holidays
• 401(k) with employer match
• Training and professional development opportunities
• Supportive and collaborative team environment