Medical Case Manager — Case Adjudication Support & Member Services

Essential Healthcare Solutions•Warner Robins, GA

11d•$21•Onsite

About The Position

Essential Healthcare Solutions is supporting Unified Health Partners for this role which processes high-volume aeromedical cases for HQ AFRC. The primary focus is on preparing cases for provider adjudication, compiling final dispositions, and serving as the unit/member help desk. This role confirms case files are complete and that provider statements match the case type and higher-level requirements, compiles final disposition packages and member mail-outs, and answers day-to-day questions from medical personnel across the force. The position requires cross-training on all team functions and rotation to cover intake and data entry during surge periods.

Requirements

Demonstrated experience processing and managing physical exams and medical standards — acquired through a military medical environment (e.g., USAF Physical Exam Standards / PES, aeromedical, or reserve medical unit) OR an equivalent civilian aeromedical, occupational health, or disability evaluation system (DES) environment.
Working knowledge of medical standards for retention, flying classes, Line of Duty (LOD) determinations, and special operational duty for the USAF; familiarity with the Aeromedical Waiver Guide (AMWG) and the Medical Standards Directory (MSD), applicable AFIs, and 422/469 and DES processes (or the ability to rapidly acquire it).
Basic knowledge of anatomy, physiology, disorders of human body systems, and emergency medical care procedures; proficiency with medical terminology and ICD-10 coding, used accurately when documenting cases.
Excellent oral and written communication; ability to translate complex medical/administrative instructions to service members at their comprehension level; project-management / workflow-tracking ability.
Proficiency with Adobe PDF and Microsoft Office (Word, Excel, Outlook, PowerPoint); proficient typing on both QWERTY and 9-key/numeric pads.
Able to work independently with strong time-management and prioritization skills; exceptional customer-service skills; fluent in reading, writing, speaking, and understanding English.
Strong interpersonal and de-escalation skills for a high-touch help-desk role; ability to communicate medical/administrative instructions clearly to members and units.
Must be able to obtain and maintain a favorable Tier 1 (T1) National Agency Check with Inquiries (NACI).
Must sign the AFRC/SG Non-Disclosure Agreement prior to beginning performance.
Must complete DoD Cyber Awareness, HIPAA, Privacy Act, and Derivative Classification training (government-provided).

Nice To Haves

In-depth knowledge of Line of Duty (LOD) determinations and Medical Evaluation Board (MEB) processes.
Prior hands-on experience in a USAF/AFRC/ARC aeromedical or reserve medical unit, or with the specific systems above (AIMWTS, ECT, PEPP) — clears the System-Experience gate with proof rather than crosswalk.

Responsibilities

Confirm all required data is included in case files for HQ AFRC provider adjudication; confirm provider statements match the case type and higher-level (e.g., PEB) requirements.
Reference and apply general medical guidelines and standards used to adjudicate cases; obtain medical opinions/recommendations from professional medical personnel.
Collect and compile data for final case disposition and member mail-out (~702 final disposition/mail-out actions per month).
Provide day-to-day advice and assistance to medical personnel across 69 units and three numbered Air Forces; receive calls and return messages within 2 duty days.
Communicate effectively with coworkers, leaders, commanders, first sergeants, MAJCOMs, and AFMEDCOM, and help resolve conflicts at different levels.
Screen and route incoming/outgoing correspondence, materials, publications, regulations, and directives; escalate items needing government attention.
Assist with disposition of LOD determinations and RILOs where applicable.
Cross-cover intake, data entry, and system-of-record updates (AIMWTS, ECT, PEPP, MEDXS) as directed to balance workload.