30-60-90 day plan for case managers
On this page
- What makes a case manager's first 90 days different?
- Which federal rules does a new hospital case manager need to know first?
- What does the 30-60-90 day plan look like?
- Which numbers should a new case manager track?
- How should the hiring manager use the plan in the final interview?
- What should each check-in cover?
- A filled example
- What does the director owe the new case manager?
- Common mistakes
- How do you adapt the plan?
- Questions people ask
A 30-60-90 day plan for a new hospital case manager should confirm in the first month that the case manager knows the Medicare rules the role is audited on (discharge planning, utilization review, the two-midnight benchmark and the patient notices), then build a caseload in stages and hand over a full caseload with tracked avoidable days and clean chart audits by day 90. As of October 2026 the federal rules include a newer notice: the Medicare Change of Status Notice for some patients moved from inpatient to observation, with its own appeal to the Quality Improvement Organization.
This plan is for the director of case management or care coordination hiring an RN or social work case manager for an acute care hospital. Payer, community and behavioral health case managers are covered in the last section. For the social work side of the team, see the 30-60-90 day plan for social workers, and for the general structure the 30-60-90 day plan template for new hires.
What makes a case manager's first 90 days different?
A hospital case manager works on two clocks at once. The clinical clock is the patient's recovery and the safest place to go next. The regulatory clock is the admission status, the notices and the payer's authorization, each with a deadline counted in hours or calendar days. A new case manager who is excellent at bedside discharge planning but misses the second notice on a weekend discharge, or does not escalate a questionable admission to the physician advisor, creates denials and patient complaints that show up weeks later.
The plan therefore front-loads the rules and the hospital's own process for each one, keeps the caseload small until the new case manager's chart audits are clean, and only then adds the improvement work that departments care about most: avoidable days and timely post-acute placement.
Which federal rules does a new hospital case manager need to know first?
These are the Medicare rules a hospital case manager works under every day, as they read in the eCFR in October 2026. State rules, payer contracts and the hospital's own policies add to them. This is not legal advice; confirm the hospital's procedures with its compliance team.
| Area | What the rule requires | Source |
|---|---|---|
| Discharge planning | Identify at an early stage the patients likely to suffer adverse health consequences without discharge planning; evaluations developed by, or under the supervision of, a registered nurse, social worker or other qualified personnel; regular re-evaluation; periodic review of a sample of discharge plans, including patients readmitted within 30 days | 42 CFR 482.43(a) |
| Post-acute choice | A list of available Medicare-participating home health agencies, SNFs, IRFs or LTCHs; the patient's freedom to choose; quality and resource use data shared to help choose; disclosure of any financial interest; documentation that the list was presented | 42 CFR 482.43(a)(8), (d) |
| Transfer protocols | Since July 1, 2025, written policies for transferring patients to the appropriate level of care, including another hospital, with annual training for relevant staff | 42 CFR 482.43(c) |
| Utilization review | A UR plan reviewing the medical necessity of admissions, duration of stays and professional services; a committee of two or more practitioners, at least two of them physicians; the attending practitioner consulted before a stay is found not medically necessary | 42 CFR 482.30 |
| Two-midnight benchmark | Inpatient admission is generally appropriate for Part A payment when the admitting physician expects care to cross two midnights, with the reasons documented in the record | 42 CFR 412.3(d) |
| Important Message from Medicare | Given at or near admission, no later than 2 calendar days after admission; a copy of the signed notice presented again before discharge, not more than 2 calendar days before discharge | 42 CFR 405.1205 |
| MOON | For Medicare patients in outpatient observation for more than 24 hours, written notice no later than 36 hours after observation starts (sooner if transferred, discharged or admitted), with an oral explanation | 42 CFR 489.20(y) |
| Change of status notice | When an inpatient is reclassified to outpatient observation and either has no Part B or stayed 3 or more consecutive days but was an inpatient for fewer than 3, written notice of appeal rights no later than 4 hours before release; the patient can ask the QIO for an expedited decision | 42 CFR 405.1210, 405.1211; CMS appeals page |
Professional standards sit alongside the regulations. The Case Management Society of America publishes the Standards of Case Management Practice, and the two common voluntary certifications are the CCM, renewed every five years with 80 hours of continuing education (8 of them in ethics) or by retaking the exam, and the ACM-RN or ACM-SW from the American Case Management Association, which asks for an RN license or a social work degree or license plus 2,080 hours of supervised, paid case management experience in a health delivery system, as of October 2026.
What does the 30-60-90 day plan look like?
30-60-90 day plan — [Name], Case Manager ([RN / SW]), [hospital]
Reports to: [director of case management] Start date: [date]
Units covered: [e.g. two medical-surgical units] Model: [UR + discharge
planning combined / split with social work]
Physician advisor: [name] Main payers: [Medicare, MA plans, Medicaid]
DAYS 1-30 — Learn the rules and the hospital's way of applying them
Goals:
- Shadow a senior case manager on each assigned unit for a full week
- Learn the medical necessity screening process the hospital uses,
when to refer to the physician advisor, and how status changes are
ordered and documented
- Walk through who delivers the IM, the MOON and the change of status
notice on each shift and weekend, and where the signed copies go
- Attend daily interdisciplinary rounds and the length-of-stay huddle
- Meet the main SNF, home health and IRF liaisons and learn the
referral portal; learn payer authorization steps for each main payer
- Read the department's last notice and discharge planning audits
Deliverables by day 30:
- Passes the department's competency check on notices and UR
- A one-page map of escalation: physician advisor, payer, ethics,
risk management, adult protective services
Check-in: day 30, with the director
DAYS 31-60 — Carry a partial caseload
Goals:
- Own all patients on one unit (example: a third to a half of a full
caseload), with a senior case manager reviewing notes weekly
- Complete initial discharge planning assessments within the
department's standard; re-evaluate when the condition changes
- Present own patients at rounds; record avoidable days with a cause
- Self-audit 10 of own charts (example number) for notice timing,
choice list documentation and UR reviews
Deliverables by day 60:
- Clean self-audit or a fix for every gap found
- Avoidable day log for the unit, with causes
Check-in: day 60
DAYS 61-90 — Full caseload and one improvement
Goals:
- Take the full caseload for the assigned units
- Cover a weekend rotation without a buddy
- Pick one recurring delay from the avoidable day log and work it
with the unit manager or a post-acute partner
Deliverables by day 90:
- Full caseload held for at least two weeks with clean audits
- The delay improvement measured against the day-60 log
Check-in: day 90 — full reviewWhich numbers should a new case manager track?
The standards in the last column are examples only. Use the department's definitions and its own history; measures like length of stay depend heavily on case mix, so judge the new case manager on the process measures they control.
| Measure | Why it matters | Example standard (example only) |
|---|---|---|
| Notice compliance (IM, MOON, change of status) | Missed or late notices are audit findings and patient rights issues | No missed notices in own audit by day 60 |
| Initial assessment timeliness | Early identification drives everything else | Within the department's standard on every own patient |
| Avoidable days by cause | Shows where stays are lengthened by process, not need | Every avoidable day has a recorded cause from day 31 |
| Referral to post-acute acceptance time | A common source of avoidable days | Tracked for own patients; delays explained |
| Status and medical necessity reviews | Drives denials and two-midnight compliance | Reviews done on time; escalations to the physician advisor documented |
| Readmissions within 30 days among own patients | The discharge planning rule asks for review of these plans | Each one reviewed for a discharge planning cause |
How should the hiring manager use the plan in the final interview?
Ask finalists to bring a short plan for your department, with a brief that names the units, the case management model and the main payers. Score it with the rubric in how to evaluate a 30-60-90 day plan in an interview. A strong plan names the notices, the physician advisor and the post-acute network in the first month and stages the caseload. Then test judgment:
- "A Medicare patient has been in observation for 30 hours and nobody has given the MOON. What do you do now?" Listen for the 36-hour limit, the oral explanation and documenting who delivered it.
- "Friday afternoon, a patient is likely to go home Monday. When does the second Important Message copy go out?" Listen for no more than 2 calendar days before discharge, and a weekend handoff.
- "The family wants a SNF the patient's plan does not cover. How do you handle the choice list?"
- "An attending disagrees with your view that the admission does not meet criteria. What happens next?"
The case manager screening questions cover the earlier rounds: credential, discharge planning rules, caseload and payer work.
What should each check-in cover?
| Checkpoint | Questions to ask | On track | Worth a direct conversation |
|---|---|---|---|
| Day 30 | "Walk me through every notice on a Friday admission that goes to observation." | Knows each deadline and who delivers it; escalation map done; has met the physician advisor and post-acute liaisons | Knows the bedside work but not the notices; still unsure when to call the physician advisor |
| Day 60 | "What did your self-audit find?" | Self-audit done honestly with fixes; avoidable days logged with causes; notes reviewed weekly without major gaps | No audit; avoidable days logged without causes; families surprised by discharge dates |
| Day 90 | "Which delay did you work on, and what changed?" | Full caseload held; one delay measured against the day-60 log; weekend rotation covered | Caseload still partial with no clear reason; improvement chosen but not measured |
A filled example
Case manager: Renee Adams (invented), RN with eight years in a step-down unit, joining the case management department of a community hospital and covering two medical units.
Day 30: Passed the notice competency check. During shadowing she noticed that on weekends the second Important Message copy for Monday discharges was often handed out on Friday, more than 2 calendar days before discharge. She raised it with her preceptor rather than changing anything herself.
Day 60: Took one unit. Her self-audit of ten charts found two choice lists presented but not documented, which she corrected in her own workflow. Her avoidable day log showed most delays on her unit came from waiting for SNF acceptance after weekend referrals.
Day 90: Took the full caseload for both units. With the director's support she agreed with two SNF liaisons to accept referrals sent by Friday noon for Saturday review. Weekend-related avoidable days on her units fell against her day-60 log. The weekend IM issue went to the director, who added a Sunday delivery step to the weekend workflow.
What does the director owe the new case manager?
- A named preceptor for the first 60 days and a weekly note review.
- Access on day one to the EHR's case management module, the screening criteria tool, payer portals and the post-acute referral system.
- The department's audit results and the hospital's notice policies, so the new case manager learns the local rules rather than a previous employer's.
- A clear split of work with social work for complex discharges, guardianship and safety concerns.
Common mistakes
| Mistake | Result | Fix |
|---|---|---|
| Full caseload in week three | Notices missed, notes copied forward | Stage the caseload; audit before adding patients |
| Teaching the bedside work but not the notices | Late MOONs and IM copies on weekends | Notice competency check before day 30 |
| Recording avoidable days without causes | No basis for an improvement | A cause on every avoidable day from day 31 |
| Steering families to preferred facilities | A patient choice violation | Present the full list and document it |
How do you adapt the plan?
- Utilization review only: drop the post-acute work and add payer clinical review submission, peer-to-peer scheduling and denial tracking by payer.
- Payer or health plan case manager: replace hospital notices with the plan's own assessment and care plan timelines and the member outreach standard; add a review of the care management platform.
- Community or Medicaid waiver case manager: replace inpatient rules with the state's waiver requirements for assessments, service plans and monthly contacts, and add home visit safety. The social worker plan covers mandated reporting duties.
- Lead or supervisor role: add the department's audit program and staffing plan, and use the nurse manager plan for the people side.
If the seat is still open, the case manager job description template sets the RN or social work requirement, credentials and caseload expectations this plan relies on.
Questions people ask
What should a new hospital case manager do in the first 30 days?
Shadow experienced case managers on each unit they will cover, learn the hospital's medical necessity screening process and its physician advisor escalation, walk through how the Important Message from Medicare, the MOON and the Medicare Change of Status Notice are delivered, and learn the post-acute network. By day 30 they should be able to explain each notice's deadline and who on the unit delivers it.
When must a hospital give the Important Message from Medicare?
Under 42 CFR 405.1205, as of October 2026, the hospital must give the notice at or near admission and no later than 2 calendar days after admission, then present a copy of the signed notice before discharge, as far in advance as possible but not more than 2 calendar days before discharge. The follow-up copy is not needed if the first notice was delivered within 2 calendar days of discharge. This is not legal advice.
How big should a new case manager's caseload be in the first 90 days?
Smaller than a full caseload until about day 60, then full by day 90 if chart audits and notice compliance are on track. The right full number depends on the unit's acuity, the split between utilization review and discharge planning, and whether social workers carry the complex discharges, so set it against the department's own standard rather than an outside figure.
Which certifications do hospital case managers hold?
The two most common are the CCM, awarded by the Commission and renewed every five years with 80 hours of continuing education including 8 hours of ethics or by retaking the exam, and the ACM from the American Case Management Association, issued as ACM-RN or ACM-SW. Both are voluntary; the RN or social work license is what the job legally requires.