Care Management Specialist

About the Role

Care Management Specialist – Eastern New Mexico Medical Center, Roswell, NM. Full‑time day shift (8:00 am – 4:30 pm, Monday‑Friday with every other weekend). The Care Management Specialist provides administrative and operational support to the Care Management team, assisting with care coordination, discharge planning, insurance verification, and documentation management. This role works closely with Care Managers, Social Workers, healthcare providers, and patients to ensure smooth transitions of care and timely access to necessary resources.

Responsibilities

• Assist the Care Management team in coordinating discharge planning, referrals, and follow‑up services to support patients’ post‑hospital care.
• Communicate with insurance providers, payers, and authorization departments to verify coverage and obtain necessary approvals for care services.
• Maintain accurate documentation of care management activities, ensuring timely entry of notes, referrals, and authorizations into the electronic medical record (EMR).
• Support patient and family communication by providing general information about discharge instructions, community resources, and follow‑up appointments.
• Coordinate with home health agencies, durable medical equipment (DME) providers, skilled nursing facilities, and other post‑acute care services to facilitate smooth care transitions.
• Review and organize patient charts, medical records, and required forms to ensure all necessary information is available for care management staff.
• Track and follow up on pending authorizations, service requests, and post‑discharge care needs, escalating concerns to Care Managers as needed.
• Assist with patient screenings and assessments, ensuring compliance with regulatory guidelines and hospital policies.
• Incorporate age‑specific considerations in discharge planning, meeting developmental and medical needs appropriately.
• Support compliance with CMS, Joint Commission, and other regulatory requirements by maintaining organized and complete documentation.
• Perform other duties as assigned, maintain regular and reliable attendance, and comply with all policies and standards.

Qualifications

• 1–2 years of experience in care coordination, case management support, patient access, or healthcare administration preferred.
• Experience in a hospital, insurance, or post‑acute care setting with knowledge of healthcare payers and authorizations preferred.
• Knowledge of care management processes, discharge planning, and post‑acute care coordination.
• Familiarity with insurance verification, prior authorizations, and healthcare payer requirements.
• Proficiency in electronic medical records (EMR) systems and healthcare documentation practices.
• Strong organizational and time‑management skills with the ability to prioritize multiple tasks.
• Excellent communication and interpersonal skills for effective collaboration with patients, families, and healthcare providers.
• Ability to problem‑solve and work independently, escalating complex issues to appropriate Care Management team members.
• Understanding of HIPAA regulations and patient confidentiality standards.

Benefits

• Comprehensive health coverage – medical, dental, & vision plans.
• Life insurance availability.
• 401(k) with employer matching for future financial security.
• Tuition reimbursement to support educational advancement.
• Competitive pay and full benefits package.
• Generous paid time off for work/life balance.