Nurse Case Manager

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

JOB INFORMATION

Effective Date:

9/1/2026

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

•

Conducts a comprehensive patient/family assessment and reviews the medical record for patients with discharge planning needs at admission and at regular intervals to initiate and maintain the discharge plan of care.

•

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.

•

Critically evaluates and analyzes physical and psychosocial assessment data.

•

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.

•

Interprets screening and selective laboratory/diagnostic tests.

•

Initiates and maintains communication and collaboration with patients/families, physicians, care team, and other stakeholders to develop, implement, and evaluate individualized discharge plans.

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Facilitates Progression to Discharge rounds.

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

•

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

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

•

Coordinates and facilitates patient progression throughout the continuum.

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Establishes a Target length of stay with an estimated discharge date and potential discharge disposition for all patients within 24-48 hours of admission.

•

Identifies, tracks, and escalates avoidable days, delays and system/process barriers to discharge impeding diagnostic/treatment progress and discharge.

•

Initiates and facilitates referrals through the Resource Center for post-acute care needs (including but not limited to placement home health care, hospice, durable medical equipment, supplies, and transportation).

•

Participates in developing consensus around discharge plan from patient/family, physician, the interdisciplinary team, and the patient’s payer.

•

Integrates payor source/program requirements and coordinates with the Resource Center to support benefit maximization and covered-day reimbursement certification; communicates payer criteria/issues with clinical staff.

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

•

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

•

Participates in clinical performance improvement activities to set goals.

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

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

•

Supports patient education needs around discharge plan and resources available.

•

Supports the UW Health outreach mission through consultation and/or education of community agencies as needed/requested.

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.

X

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

Required

or

Master's Degree

in Nursing

Required

or

Doctorate Degree

in Nursing

Required

3 years

Relevant clinical RN experience

Required

Recent experience as a 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

Basic Life Support (BLS)

Upon Hire

Required

ACMA certification as an Accredited Case Manager (ACM-RN)

Preferred

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

•

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

•

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

•

Demonstrates a working knowledge of disease and age specific impact.

•

Demonstrates ability for complex clinical decision making

•

Uses critical thinking and problem solving skills effectively

•

Excellent interpersonal communication and conflict resolution skills

•

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

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

☒

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

☐

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#

☐

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#

☐

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.