What does a medical case manager do?
The primary role of a Medical Case Manager is to monitor the patients treatment plan to ensure that physicians are doing their jobs properly. They are also responsible for improving the quality of patient services, increasing revenue, analyzing the information gathered by investigations, and reporting recommendations.
Medical case manager responsibilities
Here are examples of responsibilities from real medical case manager resumes:
- Provide clients support with basic ADL's (shopping, payee services, budgets, managing and attending appointments).
- Facilitate rehabilitation plans with TPA/Provider/Treatment team to provide professional case management services to catastrophically injure patients after auto injury.
- Collaborate with inpatient medical team and case management department to promote effective discharge planning and utilization management of hospitalize patients.
- Coordinate medical management and vocational rehabilitation.
- Attend weekly DHS case conferences to ensure client compliance and progress with obtaining and securing permanent housing.
- Report, maintain, and update case data, goal attainment, and outcomes into the HMIS system.
- Used HMIS and hard copy files to maintain, update, and report on case data and outcomes.
- Guarantee compliance with the requirements of regulatory agencies such as DCFS, DHS, CARF and ISBE provider.
- Develop vocational rehabilitation plans base on claimant's physical limitations, conduct independent labor market surveys, and job analysis.
- Perform concurrent review to assure appropriateness of admission, inpatient/acute care, rehabilitation/SNF status, and discharge using establish InterQual guidelines.
- Verify and document patient's medical history in EMR system while adhering to strict compliance with patient confidentiality and HIPAA laws.
- Secure medical records via phone and EMR.
- Assure that Medicare IM letters are signed and document in EMR system.
- Maintain confidentiality per HIPPA regulations.
- Follow HIPAA regulations regarding patient medical records and confidentiality.
Medical case manager skills and personality traits
We calculated that 18% of Medical Case Managers are proficient in Patients, Rehabilitation, and Care Coordination. They’re also known for soft skills such as Analytical skills, Detail oriented, and Leadership skills.
We break down the percentage of Medical Case Managers that have these skills listed on their resume here:
- Patients, 18%
Collaborate with inpatient medical team and case management department to promote effective discharge planning and utilization management of hospitalized patients.
- Rehabilitation, 8%
Included case specific implementation of vocational rehabilitation, utilization and bill review functions along with job analysis and modification.
- Care Coordination, 7%
Provided medical care coordination for catastrophic injuries sustained by worker and advocated on behalf of worker, family and insurance adjuster.
- Social Work, 6%
Identify patients requiring social work intervention through established case finding mechanisms.
- Home Health, 6%
Coordinated benefits advocacy, insurance authorizations for service delivery, inpatient discharge planning, home health referrals and skilled nursing placement.
- Customer Service, 6%
Impacted CorVel's ability to secure utilization review business by providing quality on-site customer service and education.
Most medical case managers use their skills in "patients," "rehabilitation," and "care coordination" to do their jobs. You can find more detail on essential medical case manager responsibilities here:
Analytical skills. The most essential soft skill for a medical case manager to carry out their responsibilities is analytical skills. This skill is important for the role because "medical and health services managers review and evaluate healthcare metrics for ways to improve efficiency and meet goals." Additionally, a medical case manager resume shows how their duties depend on analytical skills: "conduct health insurance medical risk assessment, improving the manner in which insurance companies acquire and utilize data via multi-software utilization. "
Detail oriented. Another soft skill that's essential for fulfilling medical case manager duties is detail oriented. The role rewards competence in this skill because "medical and health services managers must pay attention to detail." According to a medical case manager resume, here's how medical case managers can utilize detail oriented in their job responsibilities: "consult with claims adjusters on individual cases via telephone or e-mail, producing timely, detailed reports as required. "
Leadership skills. medical case managers are also known for leadership skills, which are critical to their duties. You can see how this skill relates to medical case manager responsibilities, because "medical and health services managers hire, train, and direct staff." A medical case manager resume example shows how leadership skills is used in the workplace: "participate in meetings with leadership and/or medical directors to discuss complicated enrollee issues, emergency room utilization and in-patient/discharge planning. "
Technical skills. medical case manager responsibilities often require "technical skills." The duties that rely on this skill are shown by the fact that "medical and health services managers must stay up to date with advances in healthcare technology, such as the coding and electronic health record (ehr) systems their facility adopts." This resume example shows what medical case managers do with technical skills on a typical day: "educated patients on technical and disease management terminology and continue to provide ongoing support and information during their care process. "
Communication skills. A commonly-found skill in medical case manager job descriptions, "communication skills" is essential to what medical case managers do. Medical case manager responsibilities rely on this skill because "medical and health services managers must convey information to their staff, other healthcare workers, and, sometimes, patients and insurance agents." You can also see how medical case manager duties rely on communication skills in this resume example: "maintained communication with claim adjusters, employers, insurance professionals, and medical professionals via phone and report generation. "
The three companies that hire the most medical case managers are:
- CorVel52 medical case managers jobs
- Crawford & Company31 medical case managers jobs
- The Independent Traveler19 medical case managers jobs
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Compare different medical case managers
Medical case manager vs. Case management specialist
In healthcare facilities, a case management specialist is in charge of ensuring that patients get quality service. Their responsibilities often include handling admission and discharge procedures, preparing and processing documents, gathering and organizing patient information, and developing strategies to optimize case management operations. There are also instances where they must address patient concerns and issues, resolving them promptly and efficiently. Furthermore, as a case management specialist, it is essential to function while adhering to the facility's policies and regulations.
While similarities exist, there are also some differences between medical case managers and case management specialist. For instance, medical case manager responsibilities require skills such as "rehabilitation," "home health," "customer service," and "behavioral health." Whereas a case management specialist is skilled in "substance abuse," "group therapy," "team planning," and "utilization management." This is part of what separates the two careers.
Case management specialists earn the highest salaries when working in the technology industry, with an average yearly salary of $55,377. On the other hand, medical case managers are paid more in the insurance industry with an average salary of $53,529.case management specialists tend to reach similar levels of education than medical case managers. In fact, case management specialists are 2.9% less likely to graduate with a Master's Degree and 2.0% less likely to have a Doctoral Degree.Medical case manager vs. Patient services manager
A patient services manager is responsible for providing high-quality medical services for the patients, implementing standard protocols and strict regulations to ensure the safety and security of the medical facility. Patient services managers monitor the adequacy of medical tools and materials, as well as inspecting the conditional efficiency of equipment and machinery. They also assist other medical professionals in performing procedures and administering medications for the patients. A patient services manager handles the departmental budget, allocating enough resources to support medical operations and functions.
In addition to the difference in salary, there are some other key differences worth noting. For example, medical case manager responsibilities are more likely to require skills like "care coordination," "social work," "management services," and "community resources." Meanwhile, a patient services manager has duties that require skills in areas such as "patient service," "tray line," "food service," and "regulatory agencies." These differences highlight just how different the day-to-day in each role looks.
Patient services managers may earn a higher salary than medical case managers, but patient services managers earn the most pay in the health care industry with an average salary of $73,953. On the other hand, medical case managers receive higher pay in the insurance industry, where they earn an average salary of $53,529.Average education levels between the two professions vary. Patient services managers tend to reach similar levels of education than medical case managers. In fact, they're 4.2% less likely to graduate with a Master's Degree and 2.0% less likely to earn a Doctoral Degree.Medical case manager vs. Medical director
A medical director is responsible for handling the overall supervision of different medical departments, managing the coordination between medical teams to ensure smooth operations and achieve high-quality care services for the patients. Medical directors enforce strict guidelines and safety measures for everyone's adherence. They also implement medical care programs, recruit medical staff, inspect the adequacy of medical equipment, respond to patient's inquiries and concerns, and oversee the facilities' procedures. A medical director manages the budget of the department, allocating equal resources to address every need.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from medical case manager resumes include skills like "care coordination," "management services," "community resources," and "mental health," whereas a medical director is more likely to list skills in "appeals," "internal medicine," "utilization management," and "psychiatry. "
Medical directors earn the highest salary when working in the insurance industry, where they receive an average salary of $242,668. Comparatively, medical case managers have the highest earning potential in the insurance industry, with an average salary of $53,529.When it comes to education, medical directors tend to earn similar degree levels compared to medical case managers. In fact, they're 2.2% less likely to earn a Master's Degree, and 24.7% less likely to graduate with a Doctoral Degree.Medical case manager vs. Medical officer
A Medical Officer delivers health and first-aid provisions for patients as well as prepares and maintains the paper and electronic health care records of clients. They ensure that all related equipment and supplies are suitably maintained at all times.
Types of medical case manager
Updated January 8, 2025
