Adaptive case management addresses the shift away from the prescriptive process-centric view of operations towards a declarative framework for operational descriptions that promotes dynamic task selection in knowledge-intensive operations. A key difference between prescriptive services and declarative services is the way by which control flow is defined. Repeatable and straight-thru processes have been successfully used to model and optimise simple activity-based value chains. Increasingly, traditional process modeling techniques are being applied to knowledge intensive activities with often poor outcomes. By taking an adaptive case management approach to knowledge-intensive services, it is possible to model and execute workflows such as medical protocols that have previously been too difficult to describe with typical BPM frameworks. In this chapter, the authors describe an approach to design-level adaptive case management leveraging off existing repositories' semantically annotated business process models.