Case Manager

A direct hire opportunity is available for a Case Manager / LPN Care Coordinator in Miami, FL. This role is ideal for an experienced Licensed Practical Nurse who wants to use clinical knowledge in a non-bedside, insurance-focused care coordination setting.

The Case Manager will support insured student members by helping them navigate healthcare services, insurance benefits, claims, referrals, authorizations, and provider access.

Responsibilities

- Conduct outreach calls to insured members to complete basic health assessments, review care needs, and follow up on active cases.

- Coordinate healthcare services for students, including locating appropriate in-network providers, facilities, specialists, DME, and home health resources when needed.

- Review medical records, utilization history, claims activity, benefits, referrals, and prior authorizations to support accurate case management.

- Assist with claims follow-up, eligibility verification, benefit questions, provider network research, and insurance navigation.

- Maintain accurate case notes while ensuring HIPAA compliance and confidentiality of all medical information.

Qualifications

3+ years of experience in health insurance, HMO setting.

Strong medical background with knowledge of medical terminology, clinical workflows, and basic chronic disease management.

Familiarity with commercial HMO/managed care, including claims, referrals, prior authorizations, and benefits.