We are seeking a medically knowledgeable and customer-focused Junior Case Management Coordinator to support our care management team. In this outreach-based role, you will proactively engage insured members with chronic conditions, recent hospitalizations, or care gaps to help facilitate timely, appropriate healthcare services. This position is ideal for candidates with a clinical background.
Key Responsibilities
- Reach out to existing insured members by phone to:
- Conduct basic health assessments
- Review care needs and follow-up status
- Provide information on available care programs and resources
- Support case managers and RNs in implementing care plans by collecting member information and scheduling services.
- Document all member interactions and clinical findings accurately in the case management system.
- Collaborate with providers, facilities, and care teams to coordinate services such as DME, home health, or specialist referrals.
- Review member utilization and claims history to flag high-risk cases for clinical staff.
- Ensure all outreach activities follow HIPAA and health plan guidelines.
- Educate members on covered benefits, preventive care, and care navigation.
Job Requirements
- LPN Degree
- Medical background required
- 5 years of experience in a healthcare, insurance, or medical office setting.
- Knowledge of clinical workflows, common medical terminology, and basic chronic disease management
- Familiarity with managed care processes (e.g., authorizations, referrals).
- Strong interpersonal and communication skills with a patient-centered approach.
- Comfortable conducting outreach calls in a high-volume, structured environment.
- Proficiency in Microsoft Office products