Case Management Specialist Job Description

Case Management Specialist Job Description

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Case management specialist provides crisis interventions and psychosocial counseling services to restore patients and families to optimum social and psychological health based on their strengths and use of available resources.

Case Management Specialist Duties & Responsibilities

To write an effective case management specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included case management specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Comply with federal, state, and municipal laws surrounding FMLA and other leave laws, short term disability policy and long term disability plan
Advising and counseling an employee through the complex aspects of the leave of absence process
Review and coordinate accommodation requests by engaging in an interactive conversation with the employee, understand their needs, finding an appropriate solution for their accommodation request
Coordinate requested ergonomic assessments with our preferred vendors
Independently evaluates case reports from all sources and routes case reports to triage
Independently monitors the safety database workflow state for approved cases that are ready for submission (FDA) / distribution (LP) and monitor E2B Gateway
Independently monitors License Partner (LP) mailbox and manages CIOMS/cases to be posted on a secure server
Completes monthly reconciliation of cases (including E2B when applicable) exchanged with LP
Identifies and proposes process improvements to improve efficiency of tasks performed on daily basis
May have to communicate directly with outside Vendors

Case Management Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Case Management Specialist

List any licenses or certifications required by the position: BLS, EHR, COHN, ACLS, NB, CDS, RTW, HIPAA

Education for Case Management Specialist

Typically a job would require a certain level of education.

Employers hiring for the case management specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Nursing, Management, Social Work, Education, Health, Business, Human Services, Health Care, Psychology, Behavioral Science

Skills for Case Management Specialist

Desired skills for case management specialist include:

Workers' compensation laws and regulations
Medical terminology
Resources available at the regional level
Applicable laws and regulations
Available health care and community resources appropriate for populations served
Current treatments and their physical and psychosocial sequelae
Data collection techniques and methods of analyzing and reporting data
Especially Medicare
Government and insurance benefits
Illnesses

Desired experience for case management specialist includes:

Identifies and communicates to management and sales teams the need for additional training and/or process improvements to maximize processing efficiency
Required 3 years of experience in clinical compliance auditing, CMS, AHCA, NCQA, EQRO or managed care environment
Years direct patient care or health education in an inpatient, skilled nursing, home health or related setting
Case management responsibilities include exercising discretion and judgment while managing cases through each stage of the leave process
Works as part of an integrated team educating employees and managers on accommodation and leave policies and processes and state/federal regulations, employee and manager responsibilities
Review, evaluate, track and monitor reasonable accommodation requests received from employees, medical providers, advocates and family members

Case Management Specialist Examples

1

Case Management Specialist Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of case management specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case management specialist
  • Clearly articulates role/responsibilities and PV knowledge for inter- and intradepartmental meetings
  • Knows when to escalate an issue and has the ability to apply critical thinking if timelines are at risk
  • Supports development and maintenance of SOPs and Work Instructions and applicable documentation specific to vendor management
  • Support PV Ops Sr
  • Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services
  • Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions
  • RN Case Managers and LVN Case Managers both gather member data
  • RN Case Managers are responsible for creating and updating a plan of care and with the active involvement of the patient and their health care team including short and long term goals with timelines and priorities for achievement
  • Interacts with case processing vendor on regular basis to ensure timely processing of adverse events reports for all investigational and marketed products
  • Evaluates all adverse event reports received from the case processing vendor for accuracy and regulatory reporting
Qualifications for case management specialist
  • Maintains highly confidential employee Personal Health Information and files
  • Bachelor degree in Healthcare, Human Resources, Business or related field
  • BS Degree with 5 - 7 years of related experience or
  • MS with 3-5 years of related experience or
  • Advanced degree in Pharmacy (PharmD) or similar with previous exposure to industry (ex
  • Bachelor’s Degree Nursing preferred
2

Case Management Specialist Job Description

Job Description Example
Our company is looking to fill the role of case management specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for case management specialist
  • Independently interacts with LPs as needed to support case processing deliverables in accordance with applicable regulations in accordance to license partner agreements
  • Works closely with medical affairs personnel for PV deliverables related to post-marketing studies/programs
  • Works closely with Regulatory personnel for regulatory submissions of adverse event reports
  • Liaise with Medical Information and Commercial leads to manage vendors and personnel directly involved with PV deliverables
  • Exercises independent judgment in managing case processing PV deliverables and maintaining compliance with SOPs, LP agreement and applicable worldwide regulations to ensure timely and consistent deliverables
  • Leads and/or contributes to continuous improvement/quality system initiatives through evaluation, development and roll out of process efficiencies applicable to internal PV Ops deliverables
  • Ensures development and maintenance of applicable SOPs, Working Practices and trainings
  • Managing multiple incoming customer request via e-mail and phone
  • Managing customer expectations and grasping customer satisfaction opportunities
  • Ensuring Service Level Agreements are met- all incoming request are addressed and cases are resolved in the agreed time within quality standards
Qualifications for case management specialist
  • AA Degree in Business/Health-Related field or equivalent experience in health care required
  • Related course work in business and computer skills preferred
  • Experience within a health care setting is preferred demonstrated competency in working for two or more persons simultaneously
  • Depending on complexity of the customer request, involving other teams to resolve
  • Coordinating support activities, planning and dispatching of HP team members and resources
  • New disruptive technology introductions sessions and key executives coffee talks
3

Case Management Specialist Job Description

Job Description Example
Our company is growing rapidly and is hiring for a case management specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for case management specialist
  • Report Adverse Drug Events that have been
  • Participates in new associate orientation and training
  • Works in collaboration with the secondary level review and physician advisors on cases to ensure correct level of care assignments
  • Investigates with resolution of unauthorized clinical days and payment denials by payer for clinical services, same working day
  • Assumes responsibility for the completion of the Florida Medicaid process for patient admission, continued stay, discharge and or post-acute services approval
  • Works collaboratively with physicians to improve the overall quality of clinical documentation reflects the patient’s presenting severity of illness for hospitalization, and to establish accurate assignment of patient status orders (observation, inpatient), concurrently, throughout the patient’s hospital stay
  • Maintains ongoing communication with medical staff, caregivers, care management team, and third party payers to set priorities, plan, organize and implement care goals directed toward best practice quality outcomes, timely and efficiently
  • Participates in the Case Management Department’s implementation and monitoring of utilization management regulatory requirements
  • Manages the preadmission screening for surgical procedures, outpatient, observation, and inpatient status/patient type for reimbursement
  • Participates in the hospital high risk screening and re-admission process improvement, and the development of innovative case management/utilization review strategies
Qualifications for case management specialist
  • This position requires you to satisfactorily complete a pre-employment physical examination
  • This position may require you to work on any day or shift
  • This position may be designated as Mission Essential and assume Essential Personnel status during inclement weather/emergencies
  • Graduate from school of nursing with current license to practice in the State of Ohio
  • Participates as a key member of the Case Management/Utilization review Team, with knowledge or regulatory agency compliance, in order to coordinate, monitor and track RAC, MAC, MIC, and other governmental denials/appeals using established processes and references
  • BS in Nursing or ASN
4

Case Management Specialist Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of case management specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for case management specialist
  • Making referrals to agencies and facilities to assist with discharge referrals and continuity of care
  • Arranging transportation as needed for patients at discharge
  • Responsible for performing a variety of tasks requiring independent judgement and initiative
  • Establishes and maintains effective working relationships with other departments/ service lines
  • Establishes and maintains strong positive communication with patients and families
  • Notarizes necessary documents as needed
  • Coordinates and prepares CM Float Pool assignments daily
  • Maintains barrier lists, analyses same Audits for completed clinical reviews and maintains a running log
  • Confirms managed care reviews are submitted timely
  • Participates in weekday CM Cn Calls, updating approval / denial info directly into ACM Auth program
Qualifications for case management specialist
  • Diploma RN or Associates Degree in Nursing, or Licensed Practical Nurse (LPN), or Bachelors social Work (BSW), Licensed Professional Counselor (LPC)
  • Experience in substance abuse and/or mental health
  • Professional integrity in handling confidential manners
  • Minimal-Physically capable of standing, walking, stooping, bending, and lifting up to ten pounds
  • Detail orientation with an ability to maintain a high level of accuracy and efficiency with data entry
  • Excellent ability to develop and implement organizational systems
5

Case Management Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of case management specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for case management specialist
  • Conducts studies and prepares reports for the utilization review committee, case mgmt
  • Formats policy and procedures
  • Compiles a variety of narrative and statistical department reports locating sources of information, develop forms
  • Coordinates meetings, maintains logs, completes and distributes minutes
  • Coordinates Provider Networking On Site , including the preparation of provider packets
  • Maintains sign in records and insures HIPPA guidelines are followed
  • Coordinates case mgmt
  • Completes PPts for in-services / training , coordinates training, issues CEUs, maintains training records
  • Maintains Case Management Shared Drive
  • Review the Compliance Documentation Management Program (CDMP) and reconciliations
Qualifications for case management specialist
  • Current Registered Nurse Michigan Licensure, Current Licensed Practical Nurse, Licensed Professional Counselor or Bachelors Social Work
  • Bachelor or Masters level Therapist preferred
  • Certification in Case Management, Utilization Review or QualityUtilization review and discharge planning experience
  • Prior customer service or secretarial experience preferred
  • Ability to organize and utilize work hours effectively and with minimal supervision
  • Master’s Degree in Social Work or related field from an accredited educational institution required

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