Clinical Case Manager

Job Description

Job Description

Salary:

Clinical Case Manager (LPN or RN)

Department: Case Management
Reports To: Director of Case Management

Position Summary

The Clinical Case Manager (LPN or RN) is responsible for coordinating, monitoring, and supporting patient care across the continuum to ensure safe, compliant, and high-quality clinical outcomes. This role integrates clinical oversight, patient advocacy, care coordination, and interdisciplinary collaboration to optimize patient engagement, treatment adherence, and continuity of care.

The clinical case manager serves as a clinical liaison between providers, medical reception, external specialists, pharmacies, laboratories, insurance entities, and community resources.

Essential Duties & Responsibilities

1. Care Coordination & Clinical Oversight
   

• Conduct patient intake assessments and ongoing clinical evaluations within scope of licensure.
• Develop, implement, and monitor individualized care plans in collaboration with providers.
• Coordinate referrals, specialty appointments, laboratory testing, imaging, and follow-ups.
• Monitor treatment adherence, medication compliance, and care plan progression.
• Identify gaps in care and proactively intervene to prevent complications or care disruptions.
• Support chronic disease management programs and preventative care initiatives.

2. Documentation & Compliance

• Maintain accurate, timely, and compliant documentation in the Electronic Health Record (EHR).
• Ensure all charting meets regulatory standards (HIPAA, OSHA, state nursing regulations).
• Assist in quality assurance audits and chart reviews.
• Ensure medication administration documentation is accurate and reconciled.
• Monitor care coordination metrics and performance indicators.

3. Patient Education & Advocacy

• Educate patients on diagnoses, medications, treatment plans, and preventative measures.
• Provide counseling on medication adherence and side-effect management.
• Assist patients with navigating insurance, prior authorizations, and medication access.
• Serve as a point of contact for clinical concerns between visits.

4. Interdisciplinary Collaboration

• Collaborate closely with providers, the front desk, and leadership to streamline workflows.
• Participate in case conferences and interdisciplinary team meetings.
• Escalate clinical concerns appropriately and timely to providers.
• Support double-booking clinical appropriateness decisions when applicable.

5. Risk Management & Quality Improvement

• Identify potential clinical risk exposures and report per policy.
• Participate in performance improvement initiatives.
• Assist in implementing evidence-based clinical practices.
• Support public health reporting when required.

Qualifications

Required

• Active, unrestricted Florida license as:
  • Licensed Practical Nurse (LPN), or
  • Registered Nurse (RN)
• Current BLS certification.
• Minimum 12 years of clinical experience in outpatient, primary care, infectious disease, or case management.
• Strong knowledge of medication administration and chronic disease management.
• Proficiency in EHR systems.

Preferred

• Experience in HIV care, infectious disease, primary care, or community health.
• Case management certification (CCM) (RN preferred).
• Knowledge of ADAP, insurance coordination, and medication assistance programs.

Competencies

• Clinical judgment and critical thinking
• High attention to detail
• Regulatory compliance awareness
• Strong documentation skills
• Professional communication
• Patient-centered approach
• Ability to manage multiple priorities in a fast-paced environment

Scope of Practice

All clinical duties must remain within the scope defined by the Florida Nurse Practice Act. LPNs will function under appropriate supervision as required by state regulations. RNs may exercise broader clinical judgment and care planning authority consistent with licensure.

Work Environment

• Outpatient medical clinic setting.
• Multi-site coordination may be required.
• Exposure to clinical environments and biohazard precautions per OSHA standards.

Why Join Our Team?

We are committed to providing compassionate, patient-centered care while fostering a culture of collaboration, professionalism, and innovation. The clinical case manager plays a vital role in ensuring continuity of care and supporting clinical excellence across all locations.