Case Manager - Pediatrics

SSM Health Physical Therapy•Crestwood, MO

1d•Onsite

About The Position

The Pediatric Case Manager plays a critical role in coordinating care for children receiving Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. This position is responsible for managing insurance authorization processes while also providing family-centered support informed by a background in social work. Under general direction, monitors and assesses the patient's plan of care from pre-admission to post-discharge. As part of the treatment team, assists the patient/family in goal setting to maximize the patient’s independence in both home and community. Interacts with payers to obtain necessary authorizations for initiating and continuing care throughout admission to the program.

Requirements

Professional Healthcare Degree in either Social Work or Licensed PT, OT, COTA, SLP
One year medical rehab case management experience (preferred)

Nice To Haves

Experience in insurance verification and pediatric social work strongly preferred.

Responsibilities

Coordinate and manage insurance authorization for PT, OT, and SLP services, including initial requests, reauthorizations, and appeals as needed
Collaborate with therapists, providers, and administrative teams to ensure timely submission of documentation required for payer approval
Monitor authorization status, track service utilization, and proactively address potential gaps in coverage
Serve as a liaison between families, providers, and insurance companies to promote continuity of care
Apply social work principles to assess family dynamics, identify barriers to care, and provide guidance or referrals for additional community resources
Support families in navigating complex healthcare and social systems, including addressing psychosocial challenges that may impact treatment adherence
Advocate for patients and families to ensure access to medically necessary services
Maintain accurate, timely documentation in compliance with regulatory and organizational standards