Case Management Specialist, Case Management, FT, 8:30A-5P

About the role

Coordinates information between the Care Management Department and Third Party Payors (Insurance Companies). Assures timely submission of utilization reviews for the hospital to effect proper reimbursement from insurance Companies and prevent denials. Serves as the department's liaison between insurance companies and the Care Manager in response to insurance requests for clinical reviews/authorizations. Maintains effective working relationships with insurance companies through ongoing communication and collaboration. Works in conjunction with Access Management and Patient Financial Services to assure accurate and timely submission of clinical reviews for appropriate reimbursement. Directs any potential denials to the Denials Coordinator and assists with the submission of missing documentation to insurance companies when necessary. Responsible for key business functions including creating and maintaining staffing schedules, managing payroll, inventory management, purchasing and invoicing. Uses effective communication skills to provide support in disseminating information to the staff. Supports operational initiatives and projects providing regular informational reports analysis and organizing data for utilization review management.

Qualifications

• Associate of Arts (AA) degree required
• Bachelor's degree preferred and/or a combination of relative work experience preferred
• Administrative experience
• Advanced computer knowledge including PowerPoint, MS Office and Excel
• Ability to operate office equipment and expand knowledge and learn new software
• Excellent verbal and written communication and interpersonal skills
• Skilled in multi-tasking, planning, critical and independent thinking
• Able to achieve results through influencing and able to maximize efficiencies while supporting fast pace work environment which may include multiple locations and leaders
• Experience with healthcare regulatory agencies preferred
• Minimum Required Experience: 4 Years

Benefits

• Career growth and development opportunities, with clear pathways and ongoing support
• Comprehensive health and wellness resources that go beyond traditional benefits
• A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
• Tuition reimbursement to support continued learning and advancement

Pay

Estimated pay range: $19.83 - $25.18 / hour depending on experience.