Case manager screening questions: CCM eligibility, discharge planning rules, caseload and care coordination
On this page
Case manager screening questions have to start by defining which case manager you mean. The title covers a hospital RN doing utilization review and discharge planning on 20 patients, a social worker coordinating housing and benefits for people with serious mental illness, a health plan nurse calling members about their medications, and a workers' compensation case manager working with adjusters. The license required, the payer rules and the daily work are different in each. Once the role is clear, screen for the license, the credential, the caseload the candidate can actually carry and the judgment they show when a patient's needs, the payer and the clock disagree.
This page covers RN and social work case managers in hospitals, health plans, community programs and post-acute care. For licensed clinical social workers in therapy roles, see the social worker screening questions; for bedside nursing, the nurse phone screen questions.
Which case manager
| Setting | Usual license | What the work is | Ask the candidate |
|---|---|---|---|
| Hospital (acute care) | RN, often paired with social workers | Utilization review, level of care, discharge planning, avoidable days | "Which criteria set did you use for status reviews, and how many patients did you carry?" |
| Emergency department | RN or social worker | Avoiding unneeded admissions, placement, observation decisions | "How did you help the ED physician decide between admission and observation?" |
| Health plan or payer | RN, sometimes social worker | Telephonic care management, transitions, prior authorization review | "How many members were on your caseload, and how often did you contact high-risk members?" |
| Community or behavioral health | Social work license or degree; varies by program | Housing, benefits, appointments, crisis linkage | "How did you keep in touch with clients who had no phone?" |
| Workers' compensation or disability | RN or certified case manager | Return to work, treatment plans, communication with adjusters and employers | "How did you handle a disagreement between the treating doctor and the adjuster?" |
Credentials and the rules hospital case managers work under
As of October 2026, not legal advice. We checked the CCM requirements against the Commission's July 2026 certification guide and the hospital rules against the federal regulation. State licensure rules for nurses and social workers vary; verify the license with the job state's board.
CCM (Certified Case Manager)
The Commission for Case Manager Certification's CCM certification guide requires a current, active and unrestricted license or certification in a health or human services discipline, or a qualifying bachelor's or graduate degree where the discipline does not require a license. Applicants also need one of three experience categories: 12 months of full-time case management supervised by a board-certified case manager, 24 months of full-time case management, or 12 months as a supervisor of case managers. Only experience within the past five years is considered; internships, practicums and volunteer work do not count. The certification is valid for five years.
If a resume lists a different case management credential, check the issuing body's own site for its requirements and verification tool before you count it.
Hospital discharge planning rules
Under 42 CFR 482.43, Medicare-participating hospitals must give patients being referred for home health, skilled nursing, inpatient rehabilitation or long-term care hospital services a list of available Medicare-participating providers serving the relevant area, inform them of their freedom to choose, respect their goals and preferences when possible, and not limit the qualified providers available. For patients in managed care plans, the hospital must tell them to check the plan's network and share network information it has. The discharge plan must also disclose any listed home health agency or skilled nursing facility in which the hospital has a disclosable financial interest. Since July 1, 2025, the same section requires written transfer policies and annual staff training on them.
A strong hospital candidate describes these steps in their own words without being prompted. One who says "we send everyone to our SNF" is describing a compliance problem.
Knockout questions
| Question | Strong answer | Red flag |
|---|---|---|
| 1. Which license do you hold, in which state, and is it active and unrestricted? | License type, number, state and expiry; verifies on the board site. | License on probation, or a multistate claim that does not check out. |
| 2. Do you hold the CCM or another case management credential? When does it expire? | Names it and the expiry; or plans to sit when eligible. | Claims CCM eligibility on experience that does not fit the categories. |
| 3. What was your caseload at your last job, and how was it measured? | A number with context (patients per day, units, members). | "It varied" with no number. |
| 4. This role includes [weekend rotation, ED coverage, travel to members' homes]. Does that work? | Specific yes or limits. | Expects Monday to Friday on a seven-day department. |
Utilization review and discharge questions
-
"Walk me through your first hour on a typical day."
- Strong answer: reviews new admissions and status, prioritizes expected discharges and barriers, attends huddles or rounds, starts referrals early.
- Red flags: starts with email and reacts all day.
-
"A patient is ready for discharge but the skilled nursing facility the family wants has no bed for four days."
- Strong answer: explains options and the list of available facilities, respects the family's choice while explaining timing, escalates avoidable-day issues, documents the conversations.
- Red flags: picks a facility for the family to free the bed.
-
"How do you handle a denial from a health plan for continued stay?"
- Strong answer: reviews the clinical documentation, arranges a peer-to-peer review with the physician advisor or attending, knows the appeal timelines, informs the patient as required.
- Red flags: "Billing deals with denials."
-
"Which criteria did you use for inpatient versus observation?"
- Strong answer: names the screening criteria tool the hospital licensed and the physician advisor's role in decisions.
- Red flags: believes the case manager decides status alone.
Care coordination and psychosocial questions
- "A patient with no stable housing is ready for discharge." Strong: assesses needs early, works with social work, shelters and community programs, avoids discharging to the street without a plan, documents.
- "A member keeps missing appointments." Strong: asks why (transportation, cost, understanding), solves the barrier, uses motivational interviewing rather than lectures.
- "Tell me about a time a patient refused the plan you recommended." Strong: respects capacity and choice, explains risks, involves the team, documents informed refusal.
- "How do you hand off a complex patient to a home health agency?" Strong: clear orders, contacts, medication list, follow-up appointments, a call to confirm the first visit.
A 15-minute phone-screen flow
- Minutes 0 to 2: setting, license required, schedule and whether the role includes utilization review.
- Minutes 2 to 5: knockout questions 1 to 4; look up the license on the state board site.
- Minutes 5 to 10: the first-hour question, the SNF bed scenario and the denial question.
- Minutes 10 to 13: one care coordination question that matches the setting.
- Minutes 13 to 15: the candidate's questions and next steps.
For health plan and community roles, swap the utilization review questions for two more care coordination questions. The scoring stays the same; only the questions behind each line change.
How case management experience gets overstated
- Bedside nursing presented as case management because "I did discharges". Ask about utilization review and payer communication.
- Prior authorization clerical work described as clinical review. Ask who made the medical necessity decision.
- Caseload numbers without context. Ask what share were active and how often they made contact.
- CCM "eligible" based on volunteer or internship time, which the Commission does not accept.
Scoring
Pass or fail
- License the client requires, active and unrestricted in the job state.
- Credential required by the client, if any, current or obtainable on the client's timeline.
- Schedule, coverage and travel accepted.
Scored 0 to 2 each (8 possible)
- Utilization review and payer knowledge.
- Discharge planning and patient choice.
- Care coordination and community resources.
- Documentation and team communication.
In the submittal, record the license and credential with expiry, settings, caseload as the candidate described it, criteria tools and documentation systems used, and a one-line summary of the SNF bed answer. For later rounds with social work candidates, the interview guide for social workers helps structure the panel, and a former director's view of the candidate's judgment is worth a reference call using the reference check template.
Questions people ask
What are the requirements for the CCM credential?
As of the Commission for Case Manager Certification's July 2026 certification guide, applicants need a current, active, unrestricted license or certification in a health or human services discipline, or a qualifying bachelor's or graduate degree where licensure is not required, plus one of three experience categories: 12 months of full-time case management supervised by a board-certified case manager, 24 months of full-time case management, or 12 months as a supervisor of case managers. Only experience within the past five years is considered, and the certification is valid for five years.
Do hospital case managers have to give patients a choice of post-acute providers?
Yes, in Medicare-participating hospitals. As of October 2026, 42 CFR 482.43(d) requires the discharge plan to include a list of available Medicare-participating home health agencies, skilled nursing facilities, inpatient rehabilitation facilities or long-term care hospitals as relevant, requires the hospital to inform the patient of their freedom to choose among them, and prohibits the hospital from limiting the qualified providers available.
Should a case manager be a nurse or a social worker?
It depends on the job. Utilization review and clinically heavy roles usually require an RN; psychosocial, community and behavioral health case management often prefer or require a social work license. Many hospital departments use both. Ask the client which licenses it accepts before you screen.
What caseload should I ask about?
Ask the candidate for their last caseload in their own terms (patients per day, members per month, units covered) and compare it with the client's model. There is no single standard number; it depends on setting, acuity and whether the role includes utilization review.