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Health Insurance Case Management Jobs (NOW HIRING)

MedStar Health

Director Case Management

Columbia, MD · On-site

Leads the enterprise case management strategy across both health plans ensuring alignment with clinical quality and financial goals. * Develops and manages the field-based activities of the Case ...

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How much do health insurance case management jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for health insurance case management in the United States is $24.76, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $26.92 per hour, depending on experience, location, and employer.

What is health insurance case management?

Health insurance case management is a collaborative process where a case manager helps individuals with complex health needs navigate their insurance benefits and access appropriate medical care. Case managers work with patients, healthcare providers, and insurance companies to ensure that patients receive the necessary treatments while managing costs and adhering to policy guidelines. They may assist with coordinating care, authorizing services, and providing support during treatment or recovery. The goal is to improve health outcomes and enhance the efficiency of care delivery.

How does a health insurance case manager typically collaborate with healthcare providers and policyholders?

Health Insurance Case Managers regularly serve as liaisons between policyholders, healthcare providers, and insurance companies. They coordinate care by reviewing medical records, authorizing treatments, and ensuring that care plans align with coverage policies. Effective communication and problem-solving are essential, as they often work with doctors, nurses, and social workers to advocate for the patient’s best interests while managing costs. Regular team meetings and case conferences are common, providing opportunities to discuss complex cases and develop strategies for improved outcomes.

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

To thrive as a Health Insurance Case Manager, you need a background in healthcare or nursing, familiarity with insurance regulations, and strong analytical skills, often supported by a degree in health-related fields and certifications such as CCM (Certified Case Manager). Proficiency with case management software, claims processing systems, and electronic health records is typically required. Excellent communication, problem-solving, and organizational skills help in coordinating care and advocating for patients. These competencies are crucial to ensure effective care management, compliance, and optimal outcomes for both clients and insurers.

What is the difference between Health Insurance Case Management vs Health Insurance Claims Processing?

AspectHealth Insurance Case ManagementHealth Insurance Claims Processing
CredentialsCertifications like CCM or CHCM often preferredTypically no specific certifications required
Work EnvironmentCollaborative, patient-focused, often in healthcare or insurance officesAdministrative, data entry, and review in insurance companies or claims centers
Job FocusCoordinating patient care, managing complex cases, ensuring appropriate servicesReviewing, processing, and approving insurance claims for payment

Health Insurance Case Management involves coordinating patient care and managing complex cases, often requiring specialized certifications. In contrast, Health Insurance Claims Processing focuses on administrative review and approval of claims, with less emphasis on direct patient interaction. Both roles are essential in the insurance industry but serve different functions and require different skill sets.

What cities are hiring for Health Insurance Case Management jobs?

Cities with the most Health Insurance Case Management job openings:

What states have the most Health Insurance Case Management jobs?

States with the most job openings for Health Insurance Case Management jobs include:

What are popular job titles related to Health Insurance Case Management jobs?

For Health Insurance Case Management jobs, the most frequently searched job titles are:

Health Insurance Case Management jobs near you
Infographic showing various Health Insurance Case Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $51,494 per year, or $24.8 per hour.

Director Case Management

Columbia, MD • On-site

MedStar Health
Health Care and Social Assistance • 10K+ employees
Learn more about MedStar Healthexternal

Full-time

Re-posted 12 hours ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 242 frontline employees who took The Breakroom Quiz

Job description

About the Job
General Summary of Position
The Director of Case Management provides strategic and operational leadership for the health plan's enterprise case management function across two health plans under a centralized clinical operations model. The Director of Case Management (DCM) is responsible for the operational functions the Case Management team including the direct supervision coaching and counseling of staff. The DCM will direct and coordinate the Case Management operations staff with specific focus on Person Centered Enrollee Care and the Enrollee Continuum of Care models. This role designs standardizes implements and optimizes care management programs to improve quality outcomes enhance enrollee experiences reduce avoidable utilization and ensure regulatory compliance. The Director of Case Management (DCM) oversees case management activities that may include behavioral health utilization management and care management functions and serves as a liaison to government and other regulatory agencies as well as internal departments. The Director monitors staff and program performance compares results against goals recommends improvements and decisions aligning with expected outcomes. The Director supports Managers managing case management coordination and care management staff. The Director ensures adherence of case management programs across markets while addressing unique state-specific regulatory and population needs partners closely with Utilization Management Pharmacy Quality Population Health Equity and Provider Relations to drive enterprise clinical performance.
Primary Duties and Responsibilities
  • Leads the enterprise case management strategy across both health plans ensuring alignment with clinical quality and financial goals.
  • Develops and manages the field-based activities of the Case Management Assessment Team (CMAT) of RN Field Case Managers to ensure person-centered enrollee care and strict contractual compliance.
  • Oversees and ensures the timely execution of Case Management activities related to Enrollee Discharge Planning Transitions of Care special benefit operations (for example transportation and personal care services) Behavioral Health Case Management and Special Population Services (for example unhoused enrollees and pediatric case management).
  • Establishes and maintains a monitored reporting cadence (for example reports and dashboards) for enrollees in case management that include annual assessments critical incidents special populations behavioral health and transitions of care coordination efforts.
  • Ensures dashboard oversight for the production and validation of case management activities including standardized goals and scorecards to support contractual compliance and both individual and health plan case management performance.
  • Standardizes case management policies workflows and documentation practices across markets while maintaining state-specific regulatory compliance.
  • Monitors and improves member engagement rates including outreach success care plan completion and sustained participation. Ensure seamless integration between Case Management and Utilization Management to reduce fragmentation and duplication of effort.
  • Partners with Pharmacy leadership to coordinate care for members utilizing high-cost or specialty medications.
  • Collaborates with Quality Improvement teams to close gaps in care and improve HEDIS and other performance metrics.
  • Develops strategies to reduce avoidable emergency department visits and hospital readmission through proactive care coordination.
  • Monitors medical expense impact and total cost of care trends related to care management interventions.
  • Establishes and monitor key performance indicators (KPIs) including engagement rates readmission rates care plan timeliness and staff productivity while driving measurable outcomes.
  • Ensures compliance with state Medicaid agencies CMS NCQA and contractual requirements across both health plans deploying corrective action plans where applicable.
  • Supervises and develops manager and supervisors ensuring strong leadership cascade and accountability within a centralized structure.
  • Designs and optimizes centralized staffing models and caseload distribution to ensure efficiency and effectiveness. Establish RE's/Reasonable Expectancy targets for the assigned work.
  • Drives continuous process improvement initiatives using data analytics and performance insights.
  • Partners with Finance and Actuarial team to evaluate the ROI of care management programs.
  • Supports value-based payment and alternative payment models aligning case management strategies with provider performance incentives.
  • Provides executive-level reporting and strategic recommendations to the VP of Clinical Operations and senior leadership.
  • Champions a culture of member-centered culturally competent care coordination that improves health equity and outcomes across both markets.
    • Minimal Qualifications
    Education
    • Bachelor's degree Nursing Social Work or related healthcare field required and
    • Master's degree Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
    Experience
    • 8-10 years Progressive experience in managed care or health plan operations. required and
    • 5-7 years Leadership experience in case management care coordination or population health management. required and
    • Demonstrated experience overseeing complex case management programs in Medicaid managed care strongly preferred. required and
    • Experience leading multi-market or centralized teams preferred. required and
    • Proven track record of improving quality outcomes reducing avoidable utilization and managing medical expense trends. required and
    • Experience with regulatory audits (state Medicaid agencies CMS) and NCQA accreditation processes. required and
    • Experience implementing risk stratification tools and data-driven care models. required and
    • Prior experience collaborating with Utilization Management Pharmacy Quality and Provider Relations functions. required
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure Active unrestricted clinical license; Multi-state licensure or eligibility for licensure in Maryland and DC.(RN strongly preferred) Upon Hire required or
    • LCSW- License Clinical Social Worker Multi-state licensure or eligibility for licensure in Maryland and DC Upon Hire required or
    • other licensed clinicians may be considered Upon Hire required and
    • CCM - Certified Case Manager Certified Case Manager (CCM) or other nationally recognized case management certification Upon Hire required
    Knowledge Skills and Abilities
    • Strong knowledge of state Medicaid CMS NCQA and contractual requirements related to case management and care coordination.
    • Deep understanding of population health management social determinants of health and risk-based care models.
    • Financial acumen with the ability to interpret PMPM trends total cost of care data and ROI analysis.
    • Expertise in care transitions complex case management maternal health behavioral health integration and high-risk population management.
    • Ability to lead organization change within a centralized clinical operations model.
    • Strong analytical skills with the ability to translate data into actionable strategy.
    • Excellent executive-level communication and presentation skills.
    • Proven ability to build high-performing teams and drive accountability.
    • Skilled in cross-functional collaboration and stakeholder engagement.
    • Demonstrated commitment to culturally competent member-centered care.
    • Proficiency with care management platforms electronic health records and reporting tools.

    This position has a hiring range of
    USD $120,702.00 - USD $238,222.00 /Yr.

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    About Medstar Health

    Sourced by ZipRecruiter

    MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

    Industry

    Health care and social assistance

    Company size

    10,000+ Employees

    Headquarters location

    Columbia, MD, US

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