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Complex Case Manager Jobs in Hawaii (NOW HIRING)

HHSC East Hawaii Region

Social Worker IV

Hilo, HI

$80K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

One (1) year of specialized social work experience performing complex case management; healthcare social work experience preferred. * Demonstrated supervisory aptitude. * Valid State of Hawaii driver ...

Advantage SCI

Program Analyst

Honolulu, HI · On-site

... complex tasks related to supporting Counterintelligence Insider Threat Program, such as: conduct ... Case Manager * Conduct weekly and monthly audits on Counter-Insider Threat investigations ...

U.S. Department of Defense (DOD)

$111K/yr

... complex case management operations and communication workflows across multiple laboratories, federal directorates, or external agencies, including leading, mentoring, or training scientific and ...

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Complex Case Manager information

See Hawaii salary details

$14

$25

$44

How much do complex case manager jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for complex case manager in Hawaii is $25.72, according to ZipRecruiter salary data. Most workers in this role earn between $20.00 and $27.98 per hour, depending on experience, location, and employer.

What other jobs can a complex case manager do?

A complex case manager can transition into roles such as care coordinator, social worker, healthcare administrator, or patient advocate, utilizing skills in case planning, communication, and problem-solving. These positions often require knowledge of healthcare systems, documentation, and sometimes additional certifications or licenses.

What is a complex case manager?

A Complex Case Manager is a healthcare professional who coordinates care for patients with multiple or serious health conditions that require comprehensive management. They assess patient needs, develop care plans, and work closely with patients, families, and healthcare providers to ensure optimal outcomes. Complex Case Managers help navigate healthcare systems, address barriers to care, and connect patients with resources, aiming to improve quality of life and reduce hospitalizations. Their role is crucial in managing cases that involve chronic illnesses, behavioral health issues, or social challenges.

What are some common challenges faced by complex case managers and how can they be addressed?

Complex Case Managers often encounter challenges such as coordinating care across multiple providers, managing high caseloads, and addressing social determinants of health that impact patient outcomes. Effective communication, strong organizational skills, and leveraging interdisciplinary teamwork are key strategies to overcome these challenges. Additionally, staying updated on resources and support services in the community can help ensure clients receive comprehensive care. Regular team meetings and ongoing professional development also support success in this dynamic role.

What are the key skills and qualifications needed to thrive as a complex case manager, and why are they important?

To thrive as a Complex Case Manager, you need a background in healthcare or social work, typically with a relevant degree and licensure such as RN, LCSW, or CCM certification. Familiarity with case management software, electronic health records (EHRs), and care coordination tools is essential. Excellent communication, critical thinking, and problem-solving skills are vital for building trust with clients and collaborating with multidisciplinary teams. These competencies ensure effective management of complex patient needs, improved outcomes, and efficient resource utilization.
Complex Case Manager jobs near you
Infographic showing various Complex Case Manager job openings in Hawaii as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $53,500 per year, or $25.7 per hour.

Concurrent Nurse Reviewer, Facility Utilization Review Unit

Hawaii Medical Service Association

Honolulu, HI

Full-time

Posted 19 days ago

Job description

  1. Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes determination of inpatient hospital stays as medically appropriate for the member's clinical condition or whether the stay requires referral to a Medical Director for potential denial. The Nurse Reviewer must follow each line of business requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each inpatient admission. Responsibilities include using effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
    • Promote improved quality of care and/or life
    • Promote cost effective medical outcomes
    • Prevent hospitalization when possible and appropriate
    • Promote decreased lengths of hospital stays when appropriate
    • Ensure the quality of care member is receiving during hospital stay is appropriate
    • Ensure appropriate levels of care are received by patients
    • Consult with Medical Directors on potential quality issues encountered during review of medical records in situations when the complexity of the member's medical, surgical and/or pharmaceutical management is unclear and may require further review or intervention and follow up with attending physicians, hospitalists or other facility staff
  2. Provide appropriate consultation and referral to Case Management or QUEST Integration program as appropriate
  3. Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available inpatient and community resources.
  4. Identifies cost savings and accurately records all communications and interventions.
  5. Evaluates suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc.
  6. Communicates timely, accurate information either verbally or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to internal MM staff, other internal departments (Claims Administration, Customer Relations, etc.), providers, members and other authorized persons. For denied services, ensures the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation and regulatory guidelines.
  7. Identifies and refers members with specific medical and/or behavioral health needs or complex case management and collaborates with case management staff as needed. Also identifies and refers quality of care issues and suspected fraud, waste or abuse to the appropriate departments.
  8. Performs all other miscellaneous responsibilities and duties as assigned or directed.
  1. Associates Degree in Nursing
  2. Current, unrestricted Nursing License in the state of Hawaii as an RN or LPN
  3. Two (2) years clinical care experience or case management or related experience.
  4. Knowledge of the appropriate protocol to be followed for a given diagnosis and the normative values of medical tests and procedures.
  5. Good typing skills
  6. Strong organizational skills
  7. Good communication skills both verbally and written
  8. Multi-tasking skills
  9. Critical thinking skills
  10. Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
  11. Currently licensed in Hawaii as an RN or LPN
    • (if applicable upon hire, proof of licensure to be provided by employee or confirmed by Human Resources)

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