Case Management Specialist

Job Description

Job Description

POSITION TITLE : Case Management Specialist

REPORTS TO : Patient Services Supervisor

POSITIONS MANAGED : None

STATUS : Non-Exempt

SUMMARY:

The Case Management Specialist is responsible for acting as a bridge between healthcare resources and patients to promote health and improved health outcomes. Assist patients with access to health insurance benefits and resources.

SALARY

This role has a target salary of $50,000 to $58,000 annually, based upon various factors including location, experience, and education.

JOB RESPONSIBILITIES

Assist individuals in obtaining health insurance to meet their healthcare needs

• Assess patient's current and historical insurance status, healthcare needs, and resource availability
• Use extensive knowledge of health insurance, including pharmacy benefit plans and plan formularies, to determine insurance needs of the patient.
• Partner with patients to secure health insurance coverage and benefits with the patient ultimately choosing a plan that best meets their needs.
• Advocate and act in the best interest of the patient with insurance and COBRA administrators, when applicable
• Follow up as necessary with patient until eligibility for insurance coverage is determined or awarded
• Stay current on various health insurance related legislation
• Provide status updates in accordance with the program parameters
• Monitor cases on an ongoing basis and provide additional resources, developing a schedule to follow up with patients
• Develop and maintain partnership with ACCESS team to ensure referral for eligible services

Conduct benefits investigations

• With proper consent, direct contact with insurance providers and pharmacy benefit managers to identify and verify patient insurance coverage
• Identify payer coverage restrictions while maintaining high quality customer service standards in compliance with federal and state regulations
• Maintain a repository of payer coverage information or case studies
• Proactively update patient-related information to patient record in the respective data platform to check ongoing status of case management
• Provide program statistical data to the leadership team on an established basis

Educate and empower patients on healthcare topics

• Partner with the leadership and executive team to plan and host health information and education sessions through several platforms
• Provide daily assistance to patients and providers with questions regarding health insurance and other resources
• Create educational health information such as videos and handouts in partnership with the Marketing team
• Represent the organization in meetings and conferences, as requested
• Perform other duties as directed

Maintain a Caseload of Individuals for contracted programs

• Meet with external grantors providing updates on case load regarding health insurance status, payments made on individual's behalf, and other communications necessary
• Continue follow up with all patients to ensure required documentation is received for continued assistance
• Provide updates to Patient Services Supervisor to allow for continued awareness of current status of individuals at all times.
• Provide assistance in locating health insurance plan options for referred individuals based on contracted program guidelines.
• Compile reporting data for supervisory review.

QUALIFICATIONS

• Bachelor's degree in Social Work, Human Services, or equivalent experience, plus 3+ years in case management.
• In-depth knowledge of private and public health insurance plans (Medicare, Medicaid, COBRA, Marketplace) and related terminology.
• Ability to obtain Certified Case Manager (CCM) credential within one year of hire.
• Strong customer service, active listening, and interpersonal skills with the ability to address complex questions and present to diverse audiences.
• Proven organizational skills to manage multiple priorities, meet deadlines, and ensure accuracy in documentation and claims processing.
• Compassion for patients with chronic conditions and commitment to delivering empathetic, high-quality support.
• Proficiency in Microsoft Word, Excel, PowerPoint, and Outlook, with experience in data tracking and reporting outcomes.

Accessia Health is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic. We are committed to fostering a diverse and inclusive workplace where all team members feel valued and respected.