Medical Case Manager

Job Description

Job Description

Job Title: Medical Case Manager (Auto Accident Clients)

Position Summary

The Medical Case Manager is responsible for coordinating and managing care for clients who have sustained injuries related to auto accidents. This role focuses on ensuring timely access to medical services, facilitating communication among providers and insurers, monitoring treatment progress, and producing accurate monthly status reports for insurance carriers. The Case Manager will conduct home visits, attend medical appointments as needed, and provide ongoing support to help clients meet treatment goals and maximize recovery.

Key Responsibilities

Care Coordination & Scheduling

• Coordinate and schedule all medical appointments, including primary care, specialists, therapy services (PT/OT/ST), diagnostic testing, pain management, behavioral health, and other recommended services.
• Confirm appointment dates/times with clients and providers; assist with rescheduling as needed to prevent gaps in care.
• Ensure referrals, authorizations, and required documentation are obtained and submitted in a timely manner.
• Collaborate with providers to support continuity of care and adherence to the treatment plan.

Home Visits & Appointment Attendance

• Conduct home visits to assess client needs, barriers to care, safety concerns, and overall progress.
• Attend provider appointments when appropriate to support the client, gather medical updates, and promote coordinated communication.
• Document visit observations and provider feedback, and communicate relevant updates to stakeholders.

Progress Monitoring & Reporting

• Track medical progress, functional status, and treatment compliance (as applicable) throughout the recovery process.
• Prepare comprehensive monthly reports for insurance companies summarizing:
• • Current treatment plan and services in place
  • Progress toward goals and functional improvements
  • Barriers to recovery and recommended supports
  • Upcoming appointments and next steps
• Maintain organized case notes and timely documentation in accordance with agency and payer standards.

Communication & Advocacy

• Serve as a liaison between clients, families/caregivers, medical providers, therapy teams, and insurance adjusters/case reviewers.
• Advocate for medically necessary services and appropriate follow-up care.
• Provide education and guidance to clients and caregivers regarding care plans, recommended services, and expectations for recovery.

Administrative & Compliance Duties

• Maintain accurate records, case files, and client communications while adhering to HIPAA and confidentiality requirements.
• Support coordination of durable medical equipment (DME), home health services, transportation resources, and community-based supports when needed.
• Participate in case conferences, interdisciplinary meetings, and internal team reviews as required.

Required Qualifications

• Bachelor’s degree in Nursing, Social Work, Health Services, Rehabilitation Counseling, or related field (required).
• Active licensure/certification as applicable (e.g., RN, LLMSW/LMSW, CCM preferred—based on role requirements).
• Minimum of 1–3 years of case management experience (injury/rehabilitation, auto accident, or insurance-related experience preferred).
• Strong knowledge of medical terminology, treatment planning, and care coordination processes.
• Ability to write clear, professional clinical summaries and insurer-facing progress reports.
• Valid driver’s license and reliable transportation for home visits and provider appointment attendance.

Preferred Skills & Competencies

• Familiarity with auto insurance/PIP processes, documentation standards, and prior authorization workflows.
• Excellent communication, organization, and time management skills.
• Ability to work independently, prioritize multiple client cases, and meet reporting deadlines.
• Strong clinical judgment, attention to detail, and professional boundaries.
• Proficiency with electronic documentation systems and Microsoft Office/Google Workspace.

Work Environment & Physical Requirements

• Combination of fieldwork (home visits/medical appointments) and office/remote administrative tasks.
• Ability to travel locally throughout the service area.
• Ability to sit/stand for extended periods and perform routine computer-based work.