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Medicare Case Manager Jobs in Virginia (NOW HIRING)

Inova

Manager Case Management

Falls Church, VA · On-site

$21.25 - $27.50/hr

Inova Fairfax Hospital is looking for a dedicated Experienced Manager Case Management to join the ... for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation ...

ComForCare

RN Case Manager - Assessment Only

Arlington, VA · On-site

$85 - $105/hr

... Case Manager (Assessment Only) to join our growing team. This is a fantastic opportunity for an ... Ensure compliance with Medicare, Medicaid, and Joint Commission guidelines during all assessment ...

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How much do medicare case manager jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for medicare case manager in Virginia is $22.76, according to ZipRecruiter salary data. Most workers in this role earn between $19.09 and $24.57 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medicare case manager?

To thrive as a Medicare Case Manager, you need a background in nursing or social work, current licensure (such as RN or LCSW), and a thorough understanding of Medicare regulations and case management principles. Familiarity with case management software, electronic health records (EHR) systems, and utilization review tools is typically required. Exceptional communication, problem-solving, and organizational skills help you coordinate care, advocate for patients, and collaborate with multidisciplinary teams. These skills are crucial for ensuring patients receive appropriate, cost-effective care while maintaining compliance with Medicare guidelines.

What are the most common challenges Medicare case managers face when coordinating care for clients, and how can they effectively address them?

Medicare Case Managers often encounter challenges such as navigating complex insurance regulations, managing high caseloads, and addressing gaps in communication between healthcare providers, patients, and families. To overcome these obstacles, successful case managers stay up to date on Medicare policies, leverage electronic health records for better coordination, and employ strong interpersonal skills to advocate for clients. Regular collaboration with multidisciplinary teams and ongoing professional development also help in providing comprehensive, patient-centered care.

What is the difference between Medicare Case Manager vs Medical Social Worker?

AspectMedicare Case ManagerMedical Social Worker
CredentialsRN, LPN, or licensed healthcare professionalMaster's in Social Work (MSW) or equivalent, licensure required
Work EnvironmentHospitals, clinics, insurance companies, home healthHospitals, community clinics, patient homes, social service agencies
Employer & IndustryHealthcare providers, insurance companies, government programsHospitals, mental health facilities, social service organizations

Medicare Case Managers primarily coordinate care for Medicare beneficiaries, focusing on healthcare plans and services. Medical Social Workers provide emotional support, counseling, and connect patients to community resources. While both roles involve patient advocacy, Medicare Case Managers are more healthcare-focused, whereas Medical Social Workers address social and emotional needs.

Is Medicare Case Manager a good career path?

Medicare Case Managers coordinate healthcare services for Medicare beneficiaries, requiring knowledge of insurance policies, healthcare regulations, and strong communication skills. The role offers stable employment with opportunities for advancement and typically requires relevant certifications or experience in healthcare or social services.

What does a Medicare case manager do?

A Medicare case manager coordinates and manages care for Medicare beneficiaries, ensuring they receive appropriate services and benefits. They assess patient needs, develop care plans, communicate with healthcare providers, and help clients navigate Medicare policies and coverage options, often using case management software. Strong organizational and communication skills are essential for this role.

What are popular job titles related to Medicare Case Manager jobs in Virginia?

For Medicare Case Manager jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Medicare Case Manager jobs in Virginia look for?

The top searched job categories for Medicare Case Manager jobs in Virginia are:

What cities in Virginia are hiring for Medicare Case Manager jobs?

Cities in Virginia with the most Medicare Case Manager job openings:

Medicare Case Manager jobs near you
Infographic showing various Medicare Case Manager job openings in Virginia as of August 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $47,334 per year, or $22.8 per hour.

Case Manager

Childrens Hospital of The Kings Daughters

Norfolk, VA • On-site

$37.13/hr

Full-time

Posted 3 days ago

New

Children's Hospital Of The King's Daughters rating

7.8

Company rating: 7.8 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

198th of 1,064 rated hospitals

Job description

  • GENERAL SUMMARY
    • The Case Manager is responsible for coordinating the case management care plan to meet the individual/caregiver needs, promoting quality, and cost-effective outcomes. This position involves identifying and resolving barriers that may hinder effective patient care and patient progression to a safe discharge in a timely manner. The Case Manager is responsible for the facilitation of clinically pertinent reviews on patient admissions for continued stay reviews including completion of certifications. Reports to department leadership.
  • ESSENTIAL DUTIES AND RESPONSIBILITIES
    • Educates and empowers individual/caregiver toward self-care and independence.
    • Collaboratively works to carry out the process of assessment, planning, facilitation, care coordination, evaluation and advocacy options and services to meet the individual's and family's comprehensive health needs.
    • Assesses the patient's plan of care and develops, implements, monitors, and documents the utilization of resources and progress of the patient through their care.
    • Interfaces with managed care organizations, external reviewers, and other payers to ensure that the admission and continued stay standards are in compliance with Centers for Medicare and Medicaid Services (CMS) standards.
    • Facilitates options and services to meet the patient's health care needs.
    • Performs all other duties as assigned.
  • LICENSES AND/OR CERTIFICATIONS
    • Preferred Licenses and/or Certifications
      • Registered Nursing License in the State of Virginia or Registered Nurse (RN) holding a valid Compact State license preferred.
      • Case Management Certification preferred.
  • MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS
    • Required Education and Experience
      • Registered Nursing License in the State of Virginia, Registered Nurse (RN) holding a valid Compact State license or Master of Social Work (MSW) from an accredited college / university required.
      • Three years or more acute care experience required.
      • Must provide record of all licensures, certifications, training, and educational requirements at the time of hire.
      • Continuous re-certification and/or maintenance of state licensures, certifications, training, educational and application requirements is required during employment.
    • Preferred Education and Experience
      • Bachelor of Science in Nursing (BSN) preferred.
        • Must provide record of a completed degree or academic transcript from an accredited program, college, or university at time of hire.
      • One year or more case management / care coordination experience preferred.
      • Three years of acute care experience in pediatric field preferred.
    • Required Knowledge, Skills, and Abilities
      • Professional knowledge of area of responsibility to direct planning and implementation of individualized service plan for eligible children with special health care needs to include medical care, social, developmental, educational, vocational, and financial aspects.
      • Possess the ability to plan, manage and establish a professional working environment within areas of responsibility.
      • Capable of identifying problems and implementing solutions for operational and organizational issues.
      • Demonstrates an understanding of the authorization process with Medicaid and other insurances as well as knowledge of Medicaid regulations.
      • Highly motivated, enthusiastic team player who takes initiative.
      • Strong organizational skills with attention to detail and commitment to accuracy.
      • Possess strong verbal and written to adequately describe patient's clinical presentation and progress in a comprehensive and concise manner.
      • Strong interpersonal skills as well as, the ability to interact with and build collegial relationships with diverse individuals.
      • Proficiency and technical aptitude with the use of Adobe Acrobat and MS Office products, including Excel, PowerPoint, Outlook, and Word.
    • Preferred Knowledge, Skills, and Abilities
      • Knowledge of utilization review and hospital finance processes preferred.
  • WORKING CONDITIONS
    • Normal office environment with little exposure to excessive noise, dust, temperature and the like.
  • PHYSICAL REQUIREMENTS
    • Click here to view physical requirements.

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