Case Manager

Palms Medical Group•Fleming Island, FL

4d•Onsite

About The Position

The Case Manager is responsible for delivering exceptional customer service and ensuring the accurate, timely, and thorough coordination of patient referrals. This role supports continuity of care by managing referral workflows, securing authorizations, and serving as a liaison between patients, providers, and external specialists. The Case Manager also identifies community resources and supports patients in overcoming barriers to care.

Requirements

Must be organized, a self-starter and detailed oriented.
Job duties require the ability to work independently and as part of a team.
Expected to multitask.
Know referral sources in one’s geographical area.
Assist in the training and mentoring of coworkers by sharing knowledge, providing guidance, and supporting skill development.
Working Knowledge of the following office equipment: Multiline Telephone, Copier, Computer, Email, Scanner, Fax Machine.
Expected to navigate and operate Microsoft Office suite products, including Word, Excel and Teams.
High School Diploma or Equivalent.
1-year prior experience in insurance verification and referrals.
Effectively communicates complex and/or technical information to co-workers, patients and/or vendors.
Standing for long periods of time.
Sitting for long periods of time.
Viewing a computer monitor for long periods of time.
Bending.
Stretching / Reaching.
Walking short distances.
Lifting up to 50 pounds.
Operating office equipment (computer, fax machines, telephones and copy machines).
Reading forms / Instructions / Patients Charts.
Communicating well to people of various ages, educational levels, cultural backgrounds in person or by telephone.
Exposure to potentially violent / irate patients.
Exposure to chemical infectious / contagious illness.
Exposure to chemical and inhalation of antibiotics during reconstitution.
Exposure to X-Ray radiation.
Exposure to a variety of scents and odors.
Must utilize universal precaution in clinical or exposure situations as prescribed by federal state, and local guidelines and /or laws.

Responsibilities

Provide professional and courteous support to patients in accordance with Palms Medical Group within his/her field of training in accordance with stated policies and procedures of PMG.
Answer, screen and route telephone calls promptly and professionally (within 3 rings).
Operate a multi-line phone system efficiently, including transferring calls, managing voicemail and navigating queues).
Document phone interactions in the EHR.
Maintain a working knowledge of all PMG departments and services.
Follow standardized referral policies and workflows.
Prioritizes referrals based on urgency and organizational goals.
Ensures complete and accurate demographic, insurance information and clinical information is submitted to specialists.
Communicate referral details and expectations to both providers and patients. including next steps and contact.
Ensure all necessary consents are obtained or coordinated.
Process incoming and outgoing patient data to support continuity of patient care.
Identify and maintain relationships with local service providers and community resources.
Assist patients in navigating to language or social barriers that may impact referral completion.
Follow EHR protocols for referral tracking.
Retrieve and document from the inbox.
Record all reports received and close open orders per PMG policy and procedure.
Ensure timely processing of all referrals.
Contact insurance companies to verify and obtain prior authorizations.
Present necessary medical information to prove medical necessity of services.
Maintain knowledge of insurance-specific authorization requirements and document accordingly.
Adhere to the Referrals Policy Manual, Medical Records Policy Manual and HIPAA Policy Manual.
Check and respond to emails at least twice daily.
Maintain patient confidentiality in compliance with HIPAA regulations.
Assist with audits and surveys as directed by the Case Manager Coordinator.
Perform any other duty assigned by the Case Manager Coordinator, Executive VP of Patient Services or CEO to improve the efficiency of PMG.