Case Manager

Our client, a healthcare consulting firm, is seeking a Case Manager for a direct hire role in Milton, GA. The Case Manager will play a crucial role in assisting clients with complex healthcare needs, navigating insurance processes, and advocating for optimal care. This role requires a strong understanding of insurance plans, healthcare systems, and state and federal programs designed to cover medical costs. The Case Manager will serve as a liaison between clients, insurance providers, and healthcare professionals, ensuring seamless coordination and support. Responsibilities Client Advocacy and Support: Serve as a primary point of contact for clients with complex healthcare needs. Advocate for clients to ensure they receive appropriate and timely care. Provide emotional support and guidance to clients and their families. Assist clients in understanding their insurance benefits and healthcare options. Case Coordination: Coordinate care between clients, members, healthcare providers, and insurance companies. Manage and track client cases, ensuring all necessary documentation is complete and accurate. Facilitate communication between all parties involved in a client's care. Assist clients with navigating insurance claims, appeals, and authorizations. Insurance and Healthcare Knowledge: Maintain a thorough understanding of various insurance plans and healthcare systems. Possess a strong understanding of state and federal programs (e.g., Medicaid, Medicare, ACA subsidies) that can assist clients in covering medical costs. Stay up to date on changes in insurance regulations and healthcare policies. Educate clients on their insurance benefits and healthcare options, including available government programs. Assist with resolving insurance-related issues and discrepancies. Documentation and Reporting: Maintain accurate and confidential client records. Prepare and submit detailed case reports and documentation. Track and report on client outcomes and progress. Ensure compliance with all relevant regulations and company policies. Collaboration and Communication: Collaborate with internal teams, insurance providers, and healthcare professionals. Communicate effectively with clients and members providing clear and concise information. Attend and participate in team meetings and training sessions. Build relationships with providers, and Insurance company personnel. State & Federal Program Navigation Partner with hospital-based case managers, social workers, discharge planners, and care coordination teams to identify patients who may qualify for Medicaid, Medicare, ACA marketplace plans, or other healthcare assistance programs. Assist clients and families with completing and submitting enrollment applications and supporting documentation for Medicaid, Medicare, and other state and federal healthcare programs. Facilitate the collection, completion, and filing of required paperwork with state and federal agencies to support timely eligibility determinations and coverage approvals. Monitor application status, communicate updates to clients and healthcare providers, and assist with resolving issues that may delay enrollment or access to care. Serve as a resource for clients navigating healthcare coverage options and eligibility requirements. Qualifications Bachelor’s degree in social work, healthcare administration, or a related field preferred. 5+ years of experience working with hospital systems, case management departments, social workers, discharge planners, or care coordination teams. Knowledge of Medicaid, Medicare, ACA marketplace plans, and other state and federal healthcare assistance programs. Experience assisting clients with eligibility determinations, enrollment applications, documentation collection, and submission processes. Familiarity with state and federal agency processes related to healthcare coverage and benefits administration. Strong understanding of insurance plans, healthcare systems, and medical terminology. Excellent communication, interpersonal, and problem-solving skills. Ability to work independently and as part of a team. Knowledge of HIPAA regulations. Proficiency in Microsoft Office Suite. Compassionate and client-focused approach. Compensation is commensurate with experience. #J-18808-Ljbffr