Nurse Case Manager

J  o  b    D  e  s  c  r  i  p  t  i  o  n

JOB INFORMATION

Effective Date:

12/1/2025

Entity:

Wisconsin

Job Code:

801009

Job Title:

Nurse Case Manager

FLSA Exemption Status:

Exempt

Management Level:

Individual Contributor

JOB SUMMARY

The Nurse Case Manager possesses well-developed knowledge and skills in the assessment and acute care management of patients. Case Manager scope of practice includes assessment of patient and caregiver needs, resource identification and establishing post-acute care plans. The Case Manager determines appropriate patient status and facilitates discharge planning with referral to all levels of care. The Nurse Case Manager participates with physicians, Social Work, and other interdisciplinary partners in the identification of barriers to care and potential solutions for the purpose of improving quality of care, changing practice, and reducing costs at the patient and system level.

ESSENTIAL DUTIES

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Clinical Case Management

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A. Assessment

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1. Conducts a comprehensive patient/family assessment for patients with identified need for discharge planning support at the time of admission. Reviews all assigned patient records at regular intervals and as requested to initiate and maintain the patient’s discharge plan of care.

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2. Reviews patient’s medical record to determine health status and risk factors and to evaluate the likelihood of the patient’s capacity for self-care and return to the pre-hospital environment.

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3. Identifies patient/family education needs and ensures that patient/family members have adequate information to participate in discharge planning and that they are given choices to the degree possible when the patient requires post-acute hospital services.

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B. Analysis

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1. Critically evaluates and analyzes physical and psychosocial assessment data.

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2. Evaluates developmental status and mental status and utilizes data to modify the discharge plan of care. Differentiates between normal and abnormal physical findings and adaptive and maladaptive behavior.

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3. Interprets screening and selective laboratory/diagnostic tests.

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C. Care Planning

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1. Initiates and maintains communication and collaboration with physicians, care team leaders, staff nurses, other care giving disciplines, and patients/families to develop, implement, and evaluate a discharge plan of care for each patient within the assigned clinical area.

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2. Facilitates Progression to Discharge rounds

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D. Intervention

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1. Acts as a clinical expert resource to the care team leader and nursing staff in planning and implementing the discharge plan of care.

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2. Utilizes financial and insurance resources of the patient to maximize the healthcare benefit.

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3. Develops a plan of continuing care when discharge outcomes are not met.

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E. Evaluation

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1. Arranges post-acute referrals for patients with health problems requiring further evaluation or additional services.

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2. Conducts concurrent utilization review.

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3. Identifies and tracks avoidable days and delays in discharge.

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Leadership

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A. Coordinates and facilitates patient progression throughout the continuum.

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1. Establishes a Target LOS with an anticipated discharge date and potential discharge disposition for all patients within 24-48 hours of admission.

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2. Identifies and facilitates resolution of system process problems impeding diagnostic or treatment progress. Identifies and resolves delays and obstacles to discharge.

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3. Initiates and facilitates referrals through the Resource Center for home health care, hospice, durable medical equipment, supplies, and transportation.

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4. Ensures and maintains consensus of discharge plan from patient/family, physician, the interdisciplinary team, and the patient’s payer.

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B. Coordinates and integrates utilization management functions and quality reviews.

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1. Applies approved utilization acuity criteria to monitor appropriateness of admissions as part of the initial and concurrent review for continued stays for all patients on assigned caseload.

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2. Identifies at risk populations using approved screening tools and adheres to established reporting procedures.

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3. Communicates with the Resource Center personnel to facilitate covered day reimbursement certification for patients and discusses payer criteria and issues with clinical staff.

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4. Demonstrates working knowledge of contractual arrangements and UW Health system fiscal accountability as it relates to appropriate application of UM functions.

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C. Collaborates with all members of the healthcare team and external customers

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1. Provides clinical consultation to physicians and UW Health staff on case management issues.

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2. Refers appropriate patients to Social Work for psychosocial intervention, guardianship, financial, and complex discharge planning in a timely manner.

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D. Participates in clinical performance improvement activities to set goals

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1. Uses data to drive decisions and plan/implement performance improvement strategies related to clinical care coordination of patients.

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2. Collects delay and other resource utilization data for specific performance and/or outcome indicators.

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E. Compliance

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1. Demonstrates a working knowledge of regulatory and survey standards (Metastar, Joint Commission, State Bureau of Quality Compliance, Center for Medicare/Medicaid Services, AHCA, NCQA).

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2. Demonstrates a working knowledge of approved criteria and applies consistently according to inter-rater reliability techniques.

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3. Demonstrates a working knowledge of disease and age specific impact.

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Education

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A. Develops, implements, and evaluates comprehensive patient education programs that assure quality and appropriateness of care across settings (inpatient, ambulatory, and home).

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B. Supports the UW Health outreach mission through consultation and/or education of community agencies as requested through the Department of Coordinated Care.

As needed, additional responsibilities reasonably within the scope of duties and physical requirements may be assigned.  ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS AND RESPECT FOR PEOPLE COMMITTMENTS.

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Clinical

Will provide all patients age and culturally appropriate assessment/screening and interpretation of clinical and laboratory data. Develops and implements age appropriate interventional plans of care including education within the parameters of their position responsibilities and licensure

JOB REQUIREMENTS

Bachelor's Degree

in Nursing. Equivalent combination of education and experience will be considered.

Required

Master's Degree

Master’s degree in Nursing or healthcare related field

Preferred

3 years

Three (3) years of relevant clinical nursing experience.

Required

Recent experience as a hospital-based Nurse Case Manager

Preferred

Licensed as a Registered Nurse (RN) in the State of WI or holds a license issued by a jurisdiction that has adopted the nurse licensure compact

Upon Hire

Required

ACMA certification as a Case Manager

Preferred

LICENSE, CERTIFICATIONS, AND REGISTRATIONS MUST BE MAINTAINED PER UW HEALTH POLICY. 

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Demonstrates ability for complex clinical decision making

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Uses critical thinking and problem solving skills effectively

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Excellent interpersonal communication and conflict resolution skills

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Computer skills in word processing, database management, and spreadsheet use

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

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Sedentary: Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.

Up to 10#

Negligible

Negligible

☐

Light: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that they can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time.

up to 20#

Up to 10# or requires significant walking or standing or requires pushing/pulling of arm/leg controls.

Negligible or constant push/pull of items of negligible weight

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Medium: Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. If someone can do medium work, we determine that they can also do sedentary and light work.

20-50#

10-25#

Negligible-10#

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Heavy: Heavy work involves lifting no more than 100 pounds at a time with frequent lifting or carrying of objects weighing up to 50 pounds. If someone can do heavy work, we determine that they can also do medium, light, and sedentary work.

50-100#

25-50#

10-20#

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Very Heavy: Very heavy work involves lifting objects weighing more than 100 pounds at a time with frequent lifting or carrying of objects weighing 50 pounds or more. If someone can do very heavy work, we determine that they can also do heavy, medium, light, and sedentary work.

Over 100#

Over 50#

Over 20#

Other - list any other physical requirements or bona fide occupational qualifications not indicated above:

Over 50 lbs.

UW Health does not require, nor does it expect that its employees lift more than 50 lbs unassisted. Objects in excess of 50 lbs should be lifted or moved with mechanical means or through a team lift. Employees in patient care areas are expected to utilize mechanical lifts and adhere to the "Use of Mechanical Lifts (Liko)" policy in the Patient Services Policy and Procedure Manual.

Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.

THE EMPLOYEE MUST BE ABLE TO COMPLETE ALL PHYSICAL REQUIREMENTS OF THE JOB WITH OR WITHOUT AN APPROVED ACCOMODATION. Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.