Case Manager

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.