Case Manager II

Passion for Patients, Equity, Kindness, Accountability, Respect and Excellence Are you ready to make a difference? About Us Patient Advocate Foundation (PAF), a national non-profit, headquartered in Hampton, VA, has been solving insurance and healthcare problems since 1996. Our mission is to actively advocate for patients living with chronic and critical illnesses, resolving the healthcare access and affordability challenges they face through the provision of case management services and financial aid. To read more about us, please visit our website at . The Ideal Candidate Do you have the drive and desire to help others? Are you a passionate advocate willing to improve our patients’ experience? PAF is seeking an organized, self-starter, who is independent and comfortable: Creating a welcoming and professional first impression by making sure patients feel comfortable and heard. Identifying problems, collecting data, establishing facts, and drawing valid conclusions. Working in a high-volume environment and dealing effectively with rapidly changing priorities. Utilizing a system of tools and IT platforms to support the rapidly changing needs of patients. The Opportunity PAF is currently seeking a Case Manager II to join our team in Hampton, VA. Case Managers actively engage to solve patient’s issues, identifying their root causes, developing a plan of action, and interacting with external stakeholders on their behalf to ensure access to care, workplace protections and preservation of their financial stability. A Case Manager II will have experience working with and knowledge of: Government programs, Social Security (SSDI/SSI), SCHIPS, Medicaid, Medicare Extra Help/Low Income Subsidy, and other social programs. Health insurance, COBRA, Medicare (all parts including supplemental plans) Medicaid (all parts including waivers, LTC, Medicare Savings), Marketplace and employer sponsored plans. To include life events that may result in a special enrollment period and open enrollment periods. Various financial assistance programs for medical costs include premium, deductible, co-insurance and co-pays and non-covered prescribed care. Appealing denials related to disability enrollment. Services and resources that support underrepresented populations. In this role, a Case Manager II will: Be the primary point of contact for patients with serious health conditions. Provide timely contact and follow up to analyze the issue(s), investigate to determine the root cause and develop a plan of action and follow through. Secure, complete and distribute appropriate applications and other forms to proper agencies. Conduct timely follow-up with both the agency and patient to ensure processing and communicate outcome(s). Provide hands on intervention, utilize conference calling to identify and connect to proven resources and support systems to resolve insured and uninsured patient healthcare access and barriers from medical cost related to their diagnosis. Screen patients for health insurance, disability, charitable programs, workplace entitlements and protection eligibility and facilitate/complete appropriate applications. Mediating with disability companies, medical providers and/or other 3rd party entities on behalf of patients when necessary to bring resolution to coverage disputes. Requesting and obtaining medical records, notes, and/or detailed bills as appropriate. Determining appropriate language for letters and preparing responses to appeal and/or charitable request. Create and send appropriate communications to patients, including follow up and closure letters, surveys and/or authorization forms, when applicable as well as supplemental educational materials. Entering and maintaining and accurate case related information into the program database throughout the engagement of the case Actively engage with patients and their families over the phone in a timely and professional manner. Qualifications If you have worked in one of these areas and are ready to put your skills to use in a different way, this role could be for you! The ideal candidate for a Case Manager II role with PAF will have: 3+ years of professional work experience in the following areas: Understanding social services/social work- play a crucial role in navigating the Disability Determination process related to social security disability claims, health care environment, government, or private disability agency, or health insurance. Hands-on experience in one or more of the following areas: Provided support to people seeking insurance coverage through Medicare, Medicaid, commercial plan and/or Marketplace; including evaluating plan options and assistance with enrollment for coverage and all available financial assistance programs (Extra Help/Low Income Subsidy; Marketplace subsidies and tax credits) Provided support to Veteran’s benefits and access to health care benefits and entitlements. Provided support to applicants applying for disability, including producing, completing, and submitting the application and following up until determination of eligibility is complete. Gathered documents and/or supporting an attorney’s office with appeal work or hearings for social security disability. Worked for an employer-based disability plan processing applications and gathering information for approval. Charitable application support Eligibility and enrollment into hospital charity care Collection or billing familiarity for a provider/hospital with emphasis on helping the patient. Ability to prioritize, organize, complete tasks timely in a fast-paced environment using technology tools to communicate and maintain confidential information. Ability to effectively communicate with callers who may be very emotional, angry, or overwhelmed. Ability to utilize technology tools and telecommunications equipment required to do the job. Ability to work in a high-volume environment and deal effectively with rapidly changing priorities. Ability to work independently, retain flexibility and maintain composure under pressure. Maintain confidentiality and comply with patient privacy guidelines. Compensation and Benefits Offers are based on relevant experience, skills, certifications and/or licensure within a healthcare environment. The offer is contingent upon favorable background and credit checks. PAF is pleased to offer our employees a comprehensive benefit package. health dental & visions options generous paid holidays vacation sick & personal leave paid winter shut down STD/LTD group life & AD&D insurance group cancer & accident plans 401k with matching a compliment of wellness programs For local Candidates: This role is Hybrid-Scheduled positions which include a mix of remote and onsite working days at our Hampton, VA location after training and mentorship period. Candidates who live in NC, GA, FL, DC, PA, and MD, t his role qualifies for a remote work schedule, once onsite training and mentorship period is completed. Now Hiring for the next Training Class starting on Monday, October 12, 2026 #J-18808-Ljbffr