Case Management Coordinator

UConn Health is an affirmative action employer, in addition to an EEO and M/F/V/PWD/PV employer. All employees are subject to adherence to the State Code of Ethics which may be found at . At UConn Health, the Case Management Coordinator supports the Case Management and Hospital Social Work teams by coordinating authorization workflows, managing payer communications, and ensuring accurate documentation of patient status, level of care, and authorizations. This role plays a critical part in maintaining regulatory compliance, supporting timely patient care, and reducing financial risk through authorization and denial management. Supervision Supervision received: Works under the supervision of an employee of higher grade. Supervision exercised: May lead/supervise lower-level employees as assigned. Responsibilities Review and process all new patient admissions, prioritizing accounts based on admission date, payer requirements, and authorization timelines. Manage work queues by sorting accounts from oldest to newest, ensuring completion of all prior-day admissions before advancing to current-day cases. Review inpatient and observation census work queues to prioritize accounts and ensure initial and concurrent authorizations are obtained and documented. Coordinate authorization activities based on payer-specific guidelines and requirements. Maintain accurate payer contact information, including phone and fax numbers, and manage an internal payer "address book" for frequently used payers not accessible through payer portals. Document authorized days in EPIC, ensuring alignment with patient status and level of care for each day of hospitalization. Identify and escalate discrepancies or disagreements regarding level of care to the appropriate care provider. Assign and track next review dates as communicated by payers, collaborating with care team to ensure timely follow-up. Route accounts which require priority or urgent clinical review to the appropriate clinical request work queues. Validate that all commercial and managed care discharges have appropriate authorizations for patient status and level of care through the designated post-discharge timeframe. Transfer discharged cases without authorization after the established timeframe to post-discharge authorization coordinators. Refer payer denials to the assigned care provider, including detailed denial reasons and peer‑to‑peer requirements. Notify the appropriate care provider of payer requests for additional clinical information and document all communications in the clinical request work queue. Confirm successful transmission and documentation of all clinical information by the care team. Manage urgent assignments, priority communications, and accounts identified through internal and external priority reports. Collaborate with Patient Access when denial reasons are related to incorrect or incomplete insurance information. Escalate unresolved issues to leadership, including delays in denial responses or peer‑to‑peer completion, repeated authorization failures after multiple payer attempts, and ongoing inaccuracies in payer information. Performs other duties as required. Minimum Qualifications Strong organizational and prioritization skills Attention to detail and accuracy in documentation Effective communication and collaboration across multidisciplinary teams Familiarity with EPIC or similar electronic health record systems Experience and Training General Experience: Five (5) years' administrative experience. Substitution allowed: Bachelor's degree and one (1) year experience in a health care setting. Preferred Requirements Knowledge of case management, utilization review, and payer authorization processes. Administrative experience in a healthcare setting. Working Conditions Requires prolonged periods of sitting and extensive use of a computer, keyboard, and mouse. Must be able to focus on detailed tasks for extended periods with minimal supervision. Incumbents may work in fast‑paced inpatient care settings and may encounter individuals and families during emotionally challenging or urgent situations. Requires walking between units, prolonged standing or sitting, and meeting patients in a variety of settings. Schedule Full time, 40 hours per week, primarily 8:00 am to 4:30 pm, Monday – Friday, rotating weekends and minor holidays as assigned, 30‑minute unpaid meal break. #J-18808-Ljbffr