Case Management Specialist, Case Management, FT, 8A-4:30P

Responsibilities

• Coordinate information between the Care Management Department and Third Party Payors (Insurance Companies).
• Assure timely submission of utilization reviews for the hospital to effect proper reimbursement from insurance companies and prevent denials.
• Serve as the department's liaison between insurance companies and the Care Manager in response to insurance requests for clinical reviews/authorizations.
• Maintain effective working relationships with insurance companies through ongoing communication and collaboration.
• Work in conjunction with Access Management and Patient Financial Services to assure accurate and timely submission of clinical reviews for appropriate reimbursement.
• Direct any potential denials to the Denials Coordinator and assist 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.
• Use effective communication skills to provide support in disseminating information to the staff.
• Support operational initiatives and projects providing regular informational reports, analysis and organizing data for utilization review management.

Qualifications

• Associate of Arts (AA) required.
• Bachelor's degree preferred and/or a combination of relevant work experience preferred.
• Administrative experience.
• Minimum Required Experience: 4 Years.

Skills

• Advanced computer knowledge including Power Point, MS Office, and Excel.
• Ability to operate office equipment and expand knowledge to 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 a fast‑paced work environment that may include multiple locations and leaders.
• Experience with healthcare regulatory agencies preferred.

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.
• And so much more.

Pay

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