Introduction Bariatric case managers (BCMs) are crucial in serving clients undergoing bariatric surgery in China. Understanding the perspectives of experienced BCMs regarding their roles in bariatric case management remains limited. This study seeks to understand the perceptions of experienced BCMs regarding their roles in bariatric care. Methods This qualitative study utilized semi-structured interviews with 29 experienced BCMs, each having more than three years of involvement in the field or experience with over 1000 patients. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results Three themes emerged regarding BCM perceptions: "The ''Prevention-Intervention-Feedback'' Closed-Loop System in Comprehensive Safety Management", "Dual Tension between Emotional Labor and Patient Empowerment", and "Professional Identity Reconstruction within Systemic Constraints". Experienced BCMs expressed mixed feelings about their roles, emphasizing safety for patient management. They also advocated standards for BCMs. Conclusion The findings highlight the unique role and contributions of the BCM within the Chinese context. Experienced BCMs prioritize patient safety while providing case management. Developing a national BCM alliance or fostering bariatric nurse specialists who establish standards for bariatric case management is essential for future professionalization. A national care and research platform is advocated for quality improvement.