Case manager interview questions
Hire the case manager who gets each patient's status right, plans a discharge the patient chose and can live with, and keeps chasing payers and agencies until the plan is real. A discharge-planning exercise, these questions and reference calls bring each of those out.
What this hire must get done
Write the scorecard before you interview, then hire against it. Set the bracketed targets from your own numbers.
MissionMove every patient to the right level of care at the right time: the right status from the first day, a safe discharge plan the patient chose, and swing beds filled with patients the hospital can care for.
- Reviews every admission and observation patient within [your policy's time frame], and sends unclear cases to [your physician advisor] the same day.
- Delivers every Important Message from Medicare and every required observation notice on time, with [your target] passing the [monthly] chart audit.
- Starts a discharge plan for every at-risk patient within [one day] of admission, with avoidable days under [your target].
- Answers every swing bed referral within [your target] with a logged yes, no or request for records.
- Reviews each readmission within [your window] with the care team and reports what changed to [the utilization review committee] each [quarter].
What to tell candidates before the interview
Say the hard parts plainly. People who wouldn't stay drop out early, and the ones who stay knew what they signed up for.
- Be clear that this person is usually the whole department: utilization review, discharge planning, Medicare notices and swing bed intake, with [your backup] when they're off.
- Give the posted schedule: [weekday hours], [your weekend rotation] and [any after-hours swing bed calls], and how each one is paid.
- Say plainly that most weeks bring a hard family conversation, such as hospice, a nursing home or a bill Medicare won't cover.
- Explain that nursing homes, agencies and hospices will ask for their referrals, and that [your gift and referral policy] applies from the first day.
How to run the interview
- Same questions, same order. Ask every candidate the questions below and the same follow-ups. It is the only way to compare people fairly.
- Two interviewers. An owner or manager and someone who does the work. Take notes on what the candidate says, not on how you feel about them.
- Score right after each answer. 5 sounds like the strong answer, 3 like the mixed one, 1 like the weak one. Use 2 and 4 for answers in between.
- Rate alone, then compare. Compare candidates question by question, and talk only after everyone has scored. Big gaps are worth a conversation.
Case manager interview questions
10 questions, each tied to the scorecard, with follow-ups and what a 5, 3 and 1 answer sound like.
Walk me through how you use [InterQual or MCG] when a patient's inpatient status is unclear.
It shows whether they treat the criteria as a screen that informs the physician, or as the decision itself.
Follow-ups
- What do you do when the criteria say observation but the attending wants inpatient?
- When do you bring in the physician advisor?
- If the review moves an inpatient to observation, what does the patient have to be told?
- 5Strong
- Treats the criteria result as a screen, talks with the attending about what the chart doesn't yet show, and sends unclear cases to the physician advisor the same day. Documents the review, knows the order is the physician's call, and knows a move to observation can mean an appeal-rights notice.
- 3Mixed
- Applies the criteria well, documents the review and refers unclear cases to the advisor, but skips the talk with the attending, so the advisor gets cases the attending could have settled.
- 1Weak
- Changes status on their own, or coaches the physician to write whatever meets the payer's rules.
A Medicare patient in observation plans to go to a nursing home for rehab and asks why their coverage might be different. What do you explain, and what do you do?
Few things anger families more than learning about observation status after the bill arrives.
Follow-ups
- How would you explain observation in plain words?
- What options would you lay out?
- What if the patient has a Medicare Advantage plan?
- 5Strong
- Confirms the status was reviewed and that the observation notice was given and explained out loud if due. Says plainly that observation time doesn't count toward the inpatient stay Original Medicare requires for skilled nursing coverage. Lays out options, checks plan rules for Medicare Advantage, and documents the talk.
- 3Mixed
- Explains the coverage effect correctly, but doesn't lay out options or check the patient's plan.
- 1Weak
- Tells the patient it will be covered, or doesn't know how observation affects skilled nursing coverage.
Walk me through how you make sure every Medicare inpatient gets the Important Message on time, including on weekends.
The notice has two deadlines, and the misses happen on weekends and short stays.
Follow-ups
- When is each copy due?
- What do you do if the patient won't sign?
- How would you show a surveyor it was done?
- 5Strong
- Checks the census daily, delivers the notice close to admission and within two calendar days, and gets a signature or notes a refusal with its date. Hands over a copy of what the patient signed before discharge when it's due, tracks both in [your EHR] and trains weekend backup.
- 3Mixed
- Meets both deadlines and covers weekends by checking in themselves, but hasn't trained a backup or set up tracking a surveyor could audit.
- 1Weak
- Relies on nursing or memory, with no way to show the notice was delivered.
Tell me about a discharge plan that fell apart on the day of discharge. What happened, and what did you change afterward?
Every case manager has had one. The answer shows whether they learn from it or blame others.
Follow-ups
- What was the first sign it might fail?
- How did you keep the patient safe that day?
- What do you do differently now?
- 5Strong
- Names the case and the cause, such as equipment not delivered or a family not ready, how the patient was kept safe that day, and a change that stuck, like confirming deliveries the day before or holding family meetings earlier.
- 3Mixed
- Handled the day well, but the lesson is vague and the way they plan stayed the same.
- 1Weak
- Blames another department, or describes no change at all.
A patient who is ready to leave lives alone far out of town, has no car, and the nearest pharmacy is an hour's drive. What do you do?
In rural care, rides, prescriptions and phone service can decide whether a patient comes back in a week.
Follow-ups
- What do you ask the patient first?
- Who in the county or community would you call?
- What has to be confirmed before they leave?
- 5Strong
- Asks what help the patient has and needs, then lines up rides through [Medicaid transport, county or volunteer services], gets prescriptions filled or delivered, books follow-up by phone or video where possible, and refers to home health if they qualify. Confirms each piece before discharge.
- 3Mixed
- Lines up the ride, prescriptions and follow-up, but doesn't confirm each one the day before discharge or check whether the patient qualifies for home health.
- 1Weak
- Discharges with written instructions only.
A patient who can make their own decisions wants to go home. Their adult child, who lives in another state, insists on a nursing home and threatens to complain. What do you do?
The case manager has to honor the patient's choice while taking the family's worries seriously.
Follow-ups
- Who do you talk to first?
- What would make you question whether going home is safe?
- How do you bring the family in?
- 5Strong
- Talks with the patient first and confirms the provider has assessed their decision-making. Honors the patient's choice, brings the family in with the patient's permission, explains the risks honestly, builds in safeguards like home health or a follow-up call, and documents the talk and the decision.
- 3Mixed
- Respects the patient's choice and sets up services, but doesn't bring the family into the plan or document the conversation.
- 1Weak
- Goes with the family because they're louder, or brushes off their concerns.
A patient needs home health after discharge. Walk me through how you help them choose an agency.
Medicare's discharge rule for critical access hospitals says to help patients choose using quality data, and steering patients to a favorite agency breaks their trust.
Follow-ups
- Where does your quality information come from?
- What do you do if the agency they want doesn't serve their area?
- What do you document?
- 5Strong
- Checks which agencies serve the patient's address and take their insurance, shares quality and resource-use data, such as Medicare's Care Compare, tied to the patient's goals, answers questions without steering, documents the choice, and sends the records the agency needs.
- 3Mixed
- Shares quality data and lets the patient choose, but doesn't check which agencies serve the patient's address or take their insurance, so the first choice falls through.
- 1Weak
- Picks the agency they always use, or the one that's easiest for the hospital.
Tell me about the hardest conversation you've had with a family about the next level of care, like hospice or a nursing home. How did you prepare, and how did it go?
These talks happen every week here, and how they go shapes what the family remembers about your hospital.
Follow-ups
- What did you find out before you walked in?
- What did you say first?
- What happened after the meeting?
- 5Strong
- Talked with the provider and knew the options first, met in private with the right people, asked what they understood before explaining, used plain words, gave choices and time, set a next step and followed up.
- 3Mixed
- Explained clearly and kindly, but left the family without a next step or a time to talk again.
- 1Weak
- Rushed it by phone, or let the family decide over the patient's wishes.
Tell me about a time a payer denied an authorization a patient needed for discharge. What did you do?
Denials are routine. The answer shows whether they push back with the right information and plan for a no at the same time.
Follow-ups
- What did you ask the payer first?
- What did you set up while you waited?
- What did you tell the patient and family?
- 5Strong
- Got the reason for the denial, sent the clinical information that answered it, set up a peer-to-peer call for the physician, worked a backup plan at the same time, kept the patient and family informed, and documented it for an appeal with the business office.
- 3Mixed
- Kept calling and got it approved, but had no backup plan, so the patient stayed extra days.
- 1Weak
- Waited for the payer, or sent the patient home without the care they needed.
Late on a Friday, a larger hospital refers a patient who needs IV antibiotics and therapy for a swing bed. The patient has a Medicare Advantage plan. How do you decide whether to accept?
Saying yes too fast fills a bed you can't staff or won't be paid for. Saying no by default sends the patient far from home.
Follow-ups
- What do you need from the referring hospital?
- Who here do you check with?
- When do you answer, and what do you log?
- 5Strong
- Gets the records, checks skilled need and the plan's authorization, confirms with nursing, therapy, pharmacy and the provider that the care can be given safely here, and answers the referring hospital that day with a yes, a no or a list of what's missing. Logs the reason for any decline.
- 3Mixed
- Checks fit and authorization correctly, but leaves the answer until Monday or doesn't log why it was declined.
- 1Weak
- Accepts without checking authorization or whether the staff can give the care, or declines without looking.
Work exercise: plan a discharge from a made-up chart
Give finalists a made-up inpatient chart: a Medicare patient going home alone with new oxygen and a walker, plus therapy and payer notes. Plant problems: time in observation before admission, a family asking for nursing home rehab, an Important Message signed at admission several days before discharge, and a family-picked agency that doesn't serve the county. In [20] minutes they write the plan, list the notices and calls due, then explain it to an interviewer playing the patient's adult child.
What to look for
- Sees that the observation days don't count toward a qualifying stay for skilled nursing coverage.
- Says the patient gets another copy of the notice they signed, before discharge.
- Finds the agency problem and offers choices that serve the county, with quality data.
- Explains the plan to the family member in plain words and checks they understood.
- Lists who to call and in what order, in the time.
Use made-up materials, never real customer work, and keep it to the time shown. Follow your own safety rules for anything hands-on.
Reference check questions
Tell finalists you'll call a former manager, and get their permission first. Ask about what they did, not whether they were nice.
- How did they handle a family that disagreed with the discharge plan?
- When their status reviews and Medicare notices were audited, what did the audits find?
- When a patient came back soon after discharge, what did they do?
- Would you rehire them to run case management on their own, and why?
Questions to skip, and what to ask instead
Ask only what the job needs. Questions that touch age, health, family or pay history can break federal, state or local law, even when you mean well.
SkipWhere did you learn Spanish?
AskAsk every candidate: many of our patients' families speak [the languages your community speaks]. Which languages can you use well enough to explain a discharge plan?
SkipDo you have young kids at home who'd make weekend coverage hard?
AskWeekend coverage is [your rotation], with [any after-hours swing bed calls]. Can you meet that schedule?
SkipWhat were you making as a case manager before?
AskAsk how they've been paid, salaried or hourly with weekend pay, then name the range, [your pay range], and ask if it works.
SkipGiven your beliefs, could you talk with families about hospice?
AskTell every candidate the job includes talking with families about hospice and end-of-life choices, then ask: tell me about a time you supported a patient's decision you wouldn't have made yourself.
Common mistakes when hiring a case manager
Hiring a great bedside nurse with no review experience
Utilization review is its own skill: criteria, payer rules and Medicare notices. A strong floor nurse can learn it, but not alone in a small hospital. If you hire one, plan the training and the physician advisor time before the start date.
Rating warmth over follow-through
The candidate who is lovely with families can still miss notice deadlines and let payer calls sit. Score the notice and payer questions as hard as the family ones, and ask references about audits.
Case manager interview FAQ
What should I ask a hospital case manager in an interview?
Ask how they use review criteria, explain observation to a patient headed to rehab, track the Important Message, help a patient choose an agency and decide on a swing bed referral. Then run the discharge-planning exercise and score each answer on the strong, mixed and weak anchors above.
Do the Medicare notice rules apply to critical access hospitals?
Yes. The rule on the Important Message from Medicare defines hospital to include critical access hospitals. So does the newer rule on appeal rights when a hospital changes an inpatient to observation. The observation notice rule names them too. It also requires staff to explain the notice out loud. If the patient won't sign, the staff member who gave it signs instead, with their name and title, a statement that it was given, and the date and time.
Does a critical access hospital have to give patients a list of agencies and nursing homes?
Read the rule before you say Medicare requires one. The critical access hospital rule asks you to help patients choose a post-acute provider using quality and resource-use data that fits their goals. The list wording in the rule for other hospitals isn't in it. A list can still help patients, so check your own policy and your accreditor's standards before you write one in or out.
Sources
- eCFR: 42 CFR 485.642, CAH discharge planning
- eCFR: 42 CFR 482.43, hospital discharge planning (for comparison)
- eCFR: 42 CFR 405.1205, notice of hospital discharge appeal rights
- eCFR: 42 CFR 405.1210, notice of appeal rights when an inpatient is changed to observation
- eCFR: 42 CFR 489.20(y), Medicare Outpatient Observation Notice
- eCFR: 42 CFR 409.30, requirements for skilled care after a hospital stay
- Medicare.gov: Care Compare
- EEOC: Pre-employment disability-related questions and medical exams
- U.S. Office of Personnel Management: Structured interviews
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