Case Management Specialist

Job Description

Job Description

Summary :

The Case Management Specialist (CMS) is a non-clinical, administrative support position that directly assists Neighborhood Service Organization (NSO) clients and case managers with activities that support the coordination and delivery of case management services., Responsibilities include client outreach, data entry, obtaining and tracking supporting documentation, facilitating referrals, coordinating follow-up activities, and providing other administrative support necessary to promote timely, organized, and person-centered services. The CMS position contributes to efficient program operations, continuity of care, and client satisfaction through effective communication, attention to detail, and timely and responsive customer service.

The Case Management Specialist typically provides support to 5–7 case managers; however, this number may change based on staffing levels and operational needs.

Responsibilities :

• Performs eligibility verification.

Verifies and ensures the cases are assigned to appropriate Case Manager and services are rendered within required timeframes as stated in workflows and policies.

• Facilitates/Schedules appointments for onsite clinic, face-to-face, or telehealth visits.

• Provides non-clinical support to Case Managers.

• Answers incoming phone calls and authorization related, or inquiry emails and responds to all phone and email requests within 2 business days, per NSO policy.

• Makes reminder and follow-up calls to clients to secure outreach on behalf of the case manager, including but not limited to reminder calls for scheduled appointments. Ensure all outreaches and incoming calls are documented in EHR.

• Provides information regarding benefits, network providers, or general program information when requested.

• Mails letters, postcards, and educational materials to clients.

• May act as liaison between the assigned area and collaborating clinics, physicians, housing coordinators, community case managers, community services, operations, and other internal departments.

• Maintains and updates case notes per workflows and policies.

• Pro-actively runs reports from the EHR and dashboards to assist Case Managers with proactively scheduling, collecting documents/signatures, and other activities related to managing caseloads.

• Follows up on cases needing closure, reopening, or creation in the electronic health record.

• May communicate on behalf of the case manager or client with clinics, doctors, community agencies, or resources for referrals when needed.

• Uploads documents, faxes, reports, and sensitive PHI to EHR as necessary.

• Responsible for workgroup voicemail.

• Promotes communication, both internally and externally, to enhance the effectiveness of case management services.

• Processes member and provider correspondence.

• Maintains and updates inbound documentation and correspondence received on behalf of clients within the electronic medical record as needed.

• May assist with coordination of benefits or clinic follow-up appointments.

• Uses NSO policies and processes to address all matters.

• Provides daily support to assigned case managers.

• All other duties as assigned.

Candidate Requirements:

• High school diploma required.

• Minimum of 1 year of experience, or any combination of education and experience that would provide an equivalent background, in clerical, medical, or psychiatric services roles.

• Previous experience in a health plan, clinic, and/or in a community setting providing clerical assistance in any of the following areas: prior authorization, case management, community psychiatric care, medical services, ambulatory care, hospital clerk, or medical assistant.

• Experience answering high-volume phone lines, triaging calls to the appropriate staff or department, and providing excellent customer service.

• Ability to respond to email and phone requests in a timely, professional, and accurate manner.

• Excellent typing skills and the ability to navigate a Windows-based environment.

• Knowledge of the Microsoft Office suite, including Outlook, Word, Excel, and PowerPoint, strongly preferred.

• Access to secure, high-speed internet and a dedicated workspace for remote or hybrid work, with the ability to protect health information and maintain HIPAA compliance.

• Must maintain a valid Michigan driver’s license or State ID and automotive insurance.

• Must have access to reliable private transportation and be able to visit locations while working for NSO.

• Additional training and credentialing may be required.

• Ability to work with an ethnically, linguistically, culturally, economically, and socially diverse population.

Preferred Qualifications:

• 1+ years of recent physical health and/or mental health/behavioral health clinical support experience.

• Experience making referrals to and coordinating with community agencies to assist in removing barriers or other disparities in healthcare.

• Understanding of managed care or Medicaid/Medicare strongly preferred.

• Strong oral, written, and interpersonal communication skills, as well as problem-solving, facilitation, and analytical skills.

Work Schedule:

• Monday through Friday between 8:30 a.m. and 5:00 p.m.

• This position works in the office for the first 90 days. After successful completion of the first six months, the position is eligible for a hybrid (remote and office) schedule.

• Required to visit the other clinics and client/guardians in the community based on the needs of the business.

Working Conditions:

• Work is performed in an office setting and, when approved, from home.

• Uses a computer, case management and mental health software, cell/telephone system, and other office equipment as needed to perform duties.

• Frequently required to stand, sit, and walk during working hours.

• May operate an automobile while performing assigned job duties.

The above elements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities and duties of personnel so classified, or a contractual commitment, and NSO retains the right to amend or revise this job description at any time.

Neighborhood Service Organization is an equal opportunity employer and values diversity in its workforce. We encourage applications from all qualified individuals, including those with diverse backgrounds and those with disabilities.