A hospital case manager is the RN who checks if each patient should be an inpatient or in observation, and plans how they go home. At a rural critical access hospital, the job also covers Medicare notices, calls to nursing homes and home health, and swing bed patients sent from bigger hospitals.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring an RN case manager to handle utilization review, discharge planning and swing bed admissions. You'll review patient status against [InterQual or MCG] criteria, plan safe discharges with patients and families, line up post-acute care, and take swing bed referrals from larger hospitals. In a hospital our size, you're often the whole department.
2. Essential Duties and Responsibilities
Review inpatient and observation status at admission and during the stay using [InterQual or MCG], and refer questions to [your physician advisor].
Start a discharge plan soon after admission and update it with the patient, family and care team.
Arrange home health, hospice, medical equipment, nursing home placement and outpatient services, giving patients the choice lists Medicare requires.
Screen swing bed referrals from other hospitals for skilled need, payer approval and a qualifying stay.
Deliver Medicare notices on time: the Important Message from Medicare to inpatients and the MOON to observation patients.
Get payer authorizations for admissions and post-acute care, and support denial appeals with the business office.
Track readmissions and avoidable days, and report them to the utilization review committee.
3. Key Tasks / Daily Activities
Review new admissions, observation patients and the swing bed census each morning.
Join the daily discharge huddle with nursing, therapy and providers.
Call payers, nursing homes, home health agencies and families.
Meet with patients and families about goals, home setup and follow-up care.
Document reviews, notices and discharge plans in [your EHR].
4. Key Performance Indicators (KPIs)
Status reviews completed on time: [your target].
Avoidable days: [your target].
Swing bed referral response time: [your target].
Unplanned readmissions: [your target].
Medicare notices delivered on time: [your target].
5. Required Qualifications and Skills
Active [State] RN license, or a multistate RN license under the Nurse Licensure Compact if your state is a member, plus current BLS.
[3+] years of acute care nursing, plus case management, utilization review or discharge planning experience.
Working knowledge of Medicare inpatient and observation rules, swing bed criteria and beneficiary notices.
Experience with [InterQual or MCG] criteria.
Clear, kind communication with patients, families and payers.
6. Preferred Experience
Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification.
Experience in a critical access hospital or swing bed program.
BSN or a master's degree in nursing.
Knowledge of local home health, hospice, nursing home and medical transport options.
7. Physical Requirements
Sit and work at a computer and phone for much of the day.
Walk the unit and ED to meet patients and families.
With or without reasonable accommodation.
8. Work Environment and Schedule
Weekday schedule: [hours], with weekend coverage on a rotation: [rotation].
Office on or near the inpatient unit, with regular time at the bedside.
Frequent phone, fax and portal work with payers and post-acute providers.
Exposure to infectious disease when visiting patients, with PPE provided.
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new case manager gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
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How case management changes at a critical access hospital
Most hospital case managers review stays and plan discharges. With 25 beds and the next level of care a long drive away, Medicare's critical access rules and swing beds change the work.
Stays are planned around 96 hours
Medicare Part A pays for an inpatient stay here only if a doctor certifies that the patient can be expected to go home or move to a hospital within 96 hours. The case manager reads each new admission with that clock in mind. When a stay starts to run long, they ask the provider early. Is it a transfer, a swing bed, or a discharge plan that's already moving? Source: eCFR: 42 CFR 424.15, requirements for inpatient CAH services.
Swing bed referrals need a qualifying stay
Larger hospitals call to send patients who need more rehab, IV antibiotics or wound care before going home. Original Medicare covers skilled care in a swing bed only after a medically needed inpatient stay of at least three days in a row. The discharge day doesn't count. Neither does time in observation or the ER, since those are outpatient. The swing bed stay usually has to start within 30 days of that discharge. For a Medicare Advantage patient, call the plan about its rules. Source: eCFR: 42 CFR 409.30, requirements for skilled care after a hospital stay.
The Important Message runs on a clock
Critical access hospitals must give every Medicare inpatient the Important Message from Medicare. It explains their rights, including how to appeal a discharge. It goes out at or near admission, and no later than two calendar days after. Before discharge, the patient gets a copy of the signed notice, no more than two days ahead. If the first one was signed within two days of discharge, the copy isn't needed. The case manager tracks both dates. Source: eCFR: 42 CFR 405.1205, notice of hospital discharge appeal rights.
Fewer places to send patients home to
The nearest open nursing home bed or home health agency may be a county or two away. Medicare's discharge rule asks the hospital to find out early what help a patient will likely need. It also asks whether that help is available, and whether the patient can get to it. Then the case manager helps the patient choose a provider. They share data on quality and resource use for home health agencies, nursing homes, rehab hospitals and long-term care hospitals. Source: eCFR: 42 CFR 485.642, CAH discharge planning.
Referral partners will court you
Nursing homes, home health agencies and hospices want this person's referrals. Some drop by with lunch or gifts. Under the federal Anti-Kickback Statute, both sides of a kickback can face criminal charges. That means whoever offers or pays something of value to get referrals for Medicare or Medicaid care, and whoever asks for or takes it. OIG lists meals among its examples. Write a gift policy with your compliance officer. Have a healthcare attorney review any deal with a post-acute provider. Source: HHS Office of Inspector General: Fraud and abuse laws.
How much hospital case managers make
The closest BLS group for hospital case managers is registered nurses. Registered nurses who work for general medical and surgical hospitals earned a median of $48.18 an hour ($100,210 a year) in May 2025, according to the Bureau of Labor Statistics. That’s about the same as the $97,550 median for registered nurses in all industries. About 1,902,960 of the 3,379,720 registered nurses in that survey work for general hospitals.
Paid at RN rates, hourly or salaried, often with a differential for weekend rotation days. Don't pay a bonus per swing bed admission or per referral unless a healthcare attorney has reviewed the plan, since Medicare pays for both.
General hospitals
$100,210$100,210 median Middle half $81,610–$118,990 10th–90th $76,270–$138,990
All industries
$97,550$97,550 median Middle half $80,330–$112,350 10th–90th $68,940–$137,470
$50k$75k$100k$125k$150k$175k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
General hospitals
$76,270
$81,610
$100,210
$118,990
$138,990
All industries
$68,940
$80,330
$97,550
$112,350
$137,470
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
Acute care nursing judgment to tell when a patient is ready to leave and when they aren't
Reads a chart fast and explains, in plain words, why a stay does or doesn't meet criteria
Kind, direct talks with families facing a nursing home or hospice decision
Keeps calling payers and facilities until a bed or an approval comes through
Documents reviews, notices and plans the same day they happen
Teach these on the job
Your InterQual or MCG criteria set, if they learned the other one
Swing bed intake rules and your referral log
The IM and MOON forms and where they live in your EHR
Your main payers' portals and authorization steps
Which agencies, nursing homes and transport services cover your counties
The job runs in your EHR's case management screens, a criteria tool such as InterQual or MCG, payer portals and a fax line, since many post-acute providers still trade referrals by fax. An RN who already knows your criteria set and your EHR needs less orientation, so list both in the posting.
Hospital case manager interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
Set each target from a year of your own data. With 25 beds, one long stay or one readmission moves a rate, so look at the cases behind each number too.
Status reviews completed on time
Count admissions and observation patients reviewed against your criteria set within your policy's time frame, using the review time stamps in the EHR. Sort the misses by weekday to find weekend gaps.
Avoidable days
Log each day a patient stayed only because of a delay: a nursing home bed, a payer approval, a ride or a test result. Group the reasons each month for the utilization review committee.
Swing bed referral response time
Time from when a referring hospital sends a swing bed request to when you answer yes, no or send for more records. Keep a log with the reason for every decline.
Unplanned readmissions
Patients who come back to this or another hospital within your chosen window, minus planned returns. Review each one with the care team. Federal rules also call for a regular review of sample discharge plans that includes readmitted patients.
Medicare notices delivered on time
Audit a sample of charts each month for a signed Important Message inside its deadlines and a MOON for each observation patient who needed one. Count notices that were late, missing or unsigned.
Career path
Registered NurseAcute care experience on the med-surg floor or in the ER.
Case ManagerRuns utilization review, discharge planning and swing bed intake, often alone.
Case management or quality directorLeads case management, utilization review or quality for a bigger hospital or a health system.
Chief Nursing OfficerWith leadership experience, leads all nursing, from the ER to swing beds.
Not under federal rules. Medicare lets a registered nurse, a social worker or other qualified staff write or oversee discharge plans at a critical access hospital. The template asks for an RN because this job also does utilization review. That means judging a patient's clinical status against InterQual or MCG criteria. If you have a social worker, you can split the work. The RN takes reviews and swing bed intake. The social worker takes placements and family meetings.
How much does a hospital case manager make?
Registered nurses who work for general medical and surgical hospitals earned a median of $48.18 an hour ($100,210 a year) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $81,610 and $118,990 a year. Pay also depends on your local market, experience and overtime.
What is the MOON, and when is it due?
It's the Medicare Outpatient Observation Notice. It tells a patient they are an outpatient getting observation care, not an inpatient. A critical access hospital must give it to Medicare patients who get more than 24 hours of observation. It's due no later than 36 hours after observation starts, or sooner if the patient is sent home, transferred or admitted. Staff may give it before the 24 hours are up.
Which case management certification should we ask for?
The template names two. The Accredited Case Manager (ACM) comes from the American Case Management Association. RNs need a current license, and social workers need a social work degree or license. Both need at least 2,080 hours of supervised, full-time paid case management work in a health care delivery system. The CCM comes from The Commission, which now calls it Board-Certified Case Manager. It pairs a license, a certification or a health or human services degree with 12 to 24 months of full-time case management work. Both are preferred, so a strong RN without either can certify later.
Can one case manager cover the whole hospital?
At 25 beds it often works, if someone covers the gaps. Decide who does weekend status reviews and swing bed calls, who hands out Medicare notices when the case manager is off, and which physician advisor answers status questions. A house supervisor or a trained staff nurse is the usual backup. Write the weekend rotation into the offer letter.
