Care Management has been in existence for years. The thrust of the role is to monitor, evaluate and enhance resource utilization while maintaining quality of care. The pivotal assumption being through enhanced patient flow, and coordinated services with appropriate resource utilization, better patient outcomes are achieved. During times of fiscal restraint, quality may become a secondary concern. This paper presents a framework to assist Care Managers, and administrators, in achieving desired outcomes that embrace fiscal accountability and quality patient care. Donabedian's model and Systems theory are the foundations for this framework.