Case Management Solutions
Case Management Solutions is a privately held healthcare services company that provides outsourced managed care case management to skilled nursing facilities, nursing homes, hospital systems, and therapy providers across all 50 US states.
- Company typePrivate
- Founded2015
- HeadquartersEnglewood Cliffs, United States
- Headcount51–100
- GTM typeB2B
- OfferingServices
What Case Management Solutions does
Case Management Solutions is a privately held healthcare services company founded in November 2015 by Jeff Rosenberg (CEO) and Steven Sax, headquartered in Englewood Cliffs, New Jersey with a second New Jersey location opened in August 2021. The company provides outsourced managed care case management services to skilled nursing facilities (SNFs), nursing homes, hospital systems, and therapy providers across all 50 US states. Its core offering consists of four product lines: Subacute HMO (short-term HMO patient authorizations), Managed Long Term Care/MLTC-MLTSS (long-term custodial care authorizations), HMO Part B (Part B authorization management and billing reconciliation), and HMO Contracting (credentialing, recredentialing, and contract negotiation including VA and Tricare agreements). CMS integrates dedicated personal case managers into client facilities to manage the full authorization lifecycle, from insurance verification through denial appeals.
The company delivers services through a custom-built management software platform deployed in April 2020 that provides real-time tracking of patient cases, trend analysis, and utilization reporting. The triple-check billing reconciliation process, combined with proactive medical necessity justification, targets the fragmented authorization workflows typical of SNF operations. Scale metrics disclosed include 100,000+ authorized days managed per month, $2 billion+ in cumulative authorizations processed, and $30 million+ in delinquent HMO agings recouped for clients. The company serves 300+ facility owners and employs a workforce of case managers, supervisors, administrators, social workers, therapists, and nurses.
The business model is professional services revenue, with no publicly disclosed pricing. The go-to-market is enterprise field sales targeting healthcare facility operators, beginning with a free facility analysis to demonstrate value before onboarding. Marketing is conducted primarily through the company website, direct outreach, and testimonials from named facility administrators and executives. The company is privately held with no disclosed institutional investors, funding rounds, or ownership changes.
Case Management Solutions firmographics
Firmographics- Name
- Case Management Solutions
- Legal name
- Case Management Solutions
- Website
- https://casemanagementsolutions.com
- Company type
- Private
- Founded year
- 2015
- Operating status
- Operating
- Headcount range
- 51–100 employees
- Short description
- Case Management Solutions is a privately held healthcare services company that provides outsourced managed care case management to skilled nursing facilities, nursing homes, hospital systems, and therapy providers across all 50 US states.
- Ownership category
- akta.pro rank
Case Management Solutions industry classification
Industry- Product category
- Healthcare Case Management Services
- SIC
- Services-Health Services (8000)
- akta.pro primary industry
- Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC) (HLADALAI)
Keywords
Where Case Management Solutions is headquartered
LocationHeadquarters
- HQ city
- Englewood Cliffs
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Case Management Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Case Management Services: Outsourced case management services for skilled nursing facilities, handling HMO/MCO authorization processes including obtaining, tracking, and managing authorizations. Services include Subacute HMO, Managed Long Term Care (MLTC/MLTSS), HMO Part B, and HMO Contracting.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels4 records
Case Management Solutions product offering
Product offeringCore offering
Case Management Solutions is an outsourced case management provider that integrates into skilled nursing facilities, nursing homes, hospital systems, and therapy providers to obtain, track, and manage HMO/MCO authorizations. Its portfolio covers short-term subacute HMO authorizations, long-term managed care (MLTC/MLTSS) custodial authorizations, HMO Part B authorizations, and contract procurement (HMO Contracting), supported by proprietary management software for utilization reporting and trend tracking.
Product overview
Case Management Solutions is an outsourced case management platform offering a suite of integrated services for skilled nursing facilities, nursing homes, hospital systems, and therapy providers. The portfolio consists of four core service offerings: Subacute HMO (for short-term HMO patients), Managed Long Term Care MLTC/MLTSS (for long-term custodial patients), HMO Part B (for Part B authorization management), and HMO Contracting (for contract procurement and negotiation). All services are delivered through a combination of dedicated personal case managers and proprietary management software that provides trend-tracking, utilization reporting, and real-time data monitoring.
Differentiator
Problem solved
Functional benefit
Products and services
- Subacute HMO Outsourced case management service providing a dedicated personal case manager focused exclusively on short-term HMO patients at skilled nursing facilities, including real-time authorizations, tracking, denial management, and appeals for subacute stays.
- Managed Long Term Care (MLTC/MLTSS) Outsourced case management for long-term care and custodial patients, providing a dedicated case manager for MLTC/MLTSS patients, including insurance verification, real-time authorizations, tracking, denial management, and billing reconciliation for ongoing stays.
- HMO Part B Outsourced case management service for HMO Part B authorizations, handling insurance verification, real-time authorizations, out-of-network authorizations, denial management, and monthly MCO billing reconciliation for SNFs, nursing homes, and therapy providers.
- HMO Contracting Contract procurement and negotiation service for healthcare facilities, including credentialing, recredentialing, medical facility ownership change management, and government contracting such as VA Agreements, Tricare for Life, and VA CCN.
Quantifiable outcome
- Over 25% of lost revenue typically comes from poor billing practices; CMS triple-check process addresses this
- +6 more outcomes
Companies that use Case Management Solutions
Customer profileNamed customers12 records
Segments4 records
Ideal customer profiles4 records
Case Management Solutions technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature1 record
Case Management Solutions partnerships and signals
Strategic signalScale indicators15 records
Recent moves6 records
Expansion highlights4 records
Case Management Solutions competitors and assessment
Company assessmentDirect peers
- CorroHealth: Outsourced revenue cycle management and case management services company serving hospitals, health systems, and post-acute providers including SNFs — operates in the same outsourced healthcare services space.
- naviHealth: Post-acute care management company (now part of Optum) providing utilization management, case management, and care coordination to SNFs, ACOs, and health plans — directly competitive with Case Management Solutions' HMO/MCO authorization business.
- AGS Health: Healthcare-focused revenue cycle management and analytics firm delivering coding, billing, and case management services to providers including skilled nursing facilities.
- Infinx Healthcare: Healthcare revenue cycle management firm providing prior authorization, medical billing, and case management services to providers — directly overlaps the HMO authorization workflow CMS sells.
- Centauri Health Solutions: Healthcare services company providing medical record retrieval, eligibility, and case management for government and commercial payers — comparable as an outsourced case management vendor.
Broad incumbents
- Conifer Health Solutions: Subsidiary of Tenet Healthcare delivering revenue cycle services and value-based care solutions across hospitals and health systems — broader incumbent offering case management as part of a wider RCM portfolio.
- Optum (UnitedHealth Group): Diversified healthcare services arm of UnitedHealth Group operating at massive scale across managed care, care delivery, and health technology — an ultimate parent competitor through its naviHealth franchise.
- R1 RCM: Leading healthcare technology and services company providing end-to-end revenue cycle management and case management workflows to hospitals and large provider systems.
Others
- PharMerica: Pharmacy services provider focused on skilled nursing facilities and senior living — adjacent service provider to the same SNF customer base as Case Management Solutions.
Emerging players
- Trella Health: Healthcare analytics platform focused on post-acute care including SNF performance, discharge planning, and care transitions — an emerging adjacent player in the SNF data and analytics layer.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights6 records
Customer concentration
Case Management Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
Case Management Solutions leadership team
Management profileNumber of profiles
Profiles2 records
Case Management Solutions funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Case Management Solutions M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Case Management Solutions
What does Case Management Solutions do?
Case Management Solutions is an outsourced case management provider that integrates into skilled nursing facilities, nursing homes, hospital systems, and therapy providers to obtain, track, and manage HMO/MCO authorizations. Its portfolio covers short-term subacute HMO authorizations, long-term managed care (MLTC/MLTSS) custodial authorizations, HMO Part B authorizations, and contract procurement (HMO Contracting), supported by proprietary management software for utilization reporting and trend tracking.
Is Case Management Solutions a public or private company?
Case Management Solutions is a private company. It is classified as founder individual operated bootstrapped and is currently operating.
When was Case Management Solutions founded?
Case Management Solutions was founded in 2015. It employs 51 to 100 people.
Where is Case Management Solutions based?
Case Management Solutions is headquartered in Englewood Cliffs, United States, in the North America region.
How does Case Management Solutions make money?
One revenue line is on record: case Management Services.
Who are Case Management Solutions's main competitors?
Direct peers on record are CorroHealth, naviHealth, AGS Health, Infinx Healthcare and Centauri Health Solutions. Broad incumbents are Conifer Health Solutions, Optum (UnitedHealth Group) and R1 RCM. PharMerica is listed as an others. Trella Health is listed as an emerging player.
Does Case Management Solutions have an API?
No public API is recorded for Case Management Solutions.
What industry is Case Management Solutions in?
Case Management Solutions's product category is Healthcare Case Management Services. Its primary akta.pro industry code is HLADALAI, Benefits, Insurance & Long-Term Care Planning Navigation (Medicare/Medicaid/LTC). Its SIC code is 8000.