Case Specialist II

Position Overview

The Case Specialist II provides direct case management support to a defined caseload of Program participants enrolled in the Virginia Birth-Related Neurological Injury Compensation Program. This role serves as a primary point of contact for assigned participants and families and supports coordination of services, communication, documentation, and navigation of Program processes. The Case Specialist II works collaboratively with Program Administration, Claims, Case Management team members, and other internal and external partners to support participant needs. This position contributes to case management operations and participates in established workflows, quality activities, and process improvements, but does not lead staff, supervise others, or independently establish Program policy or structure. This role is full-time and on-site in Richmond, VA, reporting to the Case Management Manager. This position is Exempt under the Fair Labor Standards Act (FLSA).

Duties and Responsibilities:

• Maintain responsibility for a defined caseload of Program participants.

• Serve as a consistent point of contact for assigned participants and families.

• Address concerns raised by participants and families by following up in a timely manner, clarifying Program policies and processes, identifying and supporting actionable solutions within Program parameters.

• Respond to participant inquiries in accordance with established service standards.

• Escalate complex, clinical, or high-risk issues to Case Management Manager or appropriate Program leadership or subject matter experts.

• Connect participants with appropriate community services, benefits programs, and support networks, as applicable.

• Assist participants and families with coordinating services and supports.

• Work with healthcare providers, community and healthcare provider agencies, and vendors to support participant needs.

• Support onboarding, offboarding and transition activities for participants.

• Assist with gathering and organizing documentation related to participant services.

• Maintain accurate, timely, and confidential case records in compliance with HIPAA, Program policies, and applicable privacy requirements.

• Document participant contacts, follow-up actions, and case activity in Program systems.

• Update tracking tools and records to reflect participant status and service coordination activities.

• Work collaboratively with Claims, Finance, Case Management, and Program Administration to support participant care and benefits administration.

• Participate in case reviews, team discussions, and cross-functional coordination as requested.

• Contribute to audits, quality reviews, or process improvement efforts by providing case-level documentation and information.

• Assist with special projects and other duties assigned.

• Maintain working knowledge of Program policies, procedures, and guidelines relevant to case management.

• Provide feedback to leadership on recurring issues, process gaps, or participant experience trends, as appropriate.

• Must maintain a high level of confidentiality and abide by HIPAA rules and regulations.

Qualifications:

• Demonstrated expertise in crisis intervention, conflict resolution, and de-escalation techniques.

• High tolerance and respect for individuals with diverse needs and backgrounds.

• Strong interpersonal and communication skills; ability to build trust with families under stress.

• Experience in trauma-informed care and advocacy.

• Ability to work independently and collaboratively in a multidisciplinary team.

• Ability to manage an assigned caseload and competing priorities.

• High level of discretion and ability to maintain confidentiality.

• Background as a social worker, nurse, or related helping profession preferred.

• Experience in public sector, insurance, nonprofit, or regulated healthcare environments preferred.

• Exposure to disability services, care coordination, or benefits programs preferred.

• Case management certification (e.g., CCM, ACM) preferred but not required.

Education & Experience:

• Bachelor’s degree in social work required.

• Experience in case management or related health/human services roles required.

• Additional certifications or higher education preferred but not required.

Virginia Birth Injury is an Equal Opportunity Employer. We do not discriminate in hiring or employment practices based on race, color, religion, gender, age, sexual orientation, marital or family status, national origin, non-job-related disability, or status as a veteran.