Rehabilitation Case Manager

The Licensed Case Manager is responsible for coordinating the interdisciplinary care plan, discharge planning, and patient progress communication within the inpatient rehabilitation setting. This role serves as a liaison among patients, caregivers, and the healthcare team to ensure timely and effective care transitions.

• Complete departmental orientation, as well as initial and annual competencies.
• Collaborate with interdisciplinary team members to identify barriers to care or discharge and develop appropriate solutions.
• Document patient care activities in alignment with workflow timelines, including completion of the Individual Plan of Care (IPoC) per CMS guidelines.
• Schedule family conferences and communicate progress and discharge planning with caregivers after team conferences and as needed.
• Coordinate weekly interdisciplinary team conferences to monitor treatment goals and outcomes.
• Review assigned Case Mix Group (CMG) and assist the team in identifying actively treated comorbid conditions; communicate findings to the Health Information Management (HIM) team.
• Perform other duties as assigned.

Strong communication and coordination skills required.

Ability to manage complex cases and work collaboratively with medical and non-medical staff.

The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education & License: Licensure required as a Registered Nurse, Social Worker, Respiratory Therapist, Physical Therapist, Occupational Therapist, or Speech-Language Pathologist.

Certifications: Certification in Case Management or Rehabilitation Nursing preferred (e.g., CCM, ACM, RN-BC, ARN).

Experience: Minimum of 2 years of experience in social work or case management in an inpatient setting preferred; acute rehabilitation hospital experience strongly preferred.

Skills: Effective oral and written communication in English; additional languages preferred. Proficiency in Microsoft Office applications required.