Senior Case Manager Job Description
Senior case manager
provides guidance & training to state agencies, health care providers, employees, vendors & consultants regarding benefit plan processing policies & procedures.
Senior Case Manager Duties & Responsibilities
To write an effective senior case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included senior case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Proactively communicating with the customer to evaluate their history, medical treatment, level of function and abilities, social network
Serves as a patient advocate by communicating with insurance companies, 501c3 organizations any other organizations offering services to patients in need
Guides patients through enrollment periods through both commercial and government payers nonprofit organizations offering assistance
Monitor and work with patients approaching Medicare eligibility to ensure appropriate placement in Parts A, B, & D plans supplemental and Gap coverage where necessary
Routinely meet with Managed Markets and Corporate Account Directors support other internal teams to ensure all business objectives are being met
May also be responsible for providing health education, coaching and treatment decision support for members
Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payors
Acquire/Exhibit/Maintain subject matter expertise in the area of the liver disease, including but not limited to the condition, treatment, community of patients and caregivers, activities and events offered throughout the country, , to ensure staff is providing the appropriate support / service(s)
Serves as expert on all aspects of the end-to-end case management processes with regards to global regulations, guidelines and industry best practices
Ensures compliance with global regulations and guidelines with regards to safety data collections, management and reporting related to individual case management activities
Senior Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Senior Case Manager
List any licenses or certifications required by the position: URAC, RUG, CPR, BLS, CCM, PHN, ACAMS, CIC, LOMA, CPDM
Education for Senior Case Manager
Typically a job would require a certain level of education.
Employers hiring for the senior case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and University Degree in Education, Social Work, Health, Nursing, Business, Economics, Management, Finance, Law, Math
Skills for Senior Case Manager
Desired skills for senior case manager include:
General business and administrative practices
Federal and state regulations
Laws and accreditation standards related to health care and managed care organizations
KP Health Plan benefits plan/contracts/systems strongly .Excellent interpersonal
Member complaint and grievance processing
Verbal and written communication skills
Benefit plan design
Kaiser Permanente Health Plan benefit plan/contracts/systems strongly
MS Word
Member grievance and appeals processing
Desired experience for senior case manager includes:
Demonstrated conflict resolution and mediation skills with ability to secure action from multiple stakeholders
Ability to use sound judgment and to handle complex issues independently, but with the knowledge and ability to escalate and ask for help when needed
Ability to work with peers in self-managed teams
Viewed as functional expert in field within KP
Active RN license in the state(s) in which the nurse is required to practice (Kansas, Missouri, Oklahoma & Arkansas)
Thorough knowledge of UM, case management and discharge planning
Senior Case Manager Examples
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Senior Case Manager Job Description
Job Description Example
Our company is hiring for a senior case manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for senior case manager
- Collaborates with GDS Ops lead & cross functionally in implementing procedures to obtaining critical or missing Adverse Event (AE) or Serious Adverse Events (SAEs) information to ensure appropriate medical assessments
- Oversee vendor processes to ensure that Global/GDS standards are adhered to for the execution of the medical review of ICSRs (narratives, coding, expectedness, causality and seriousness) to ensure quality reports
- Accountable for data reconciliation between the safety database and other databases as required (e.g., Medical Information, Quality, Patient Support Programs, Clinical, Market Research) to ensure compliance with global regulation
- Play an active role in data migration or transfer from different database and support development/update of guidance’s and data entry conventions for consistent case processing
- Provide oversight and participates in the Quality Assurance of ICSRs, collection of metrics & trending to ensure proper mitigation measure are put in place to ensure high quality report produce by safety vendor
- Collaborate/review and sign off on deviations/corrective & preventative actions developed and implemented by vendor due to failure to comply with procedures
- Participates in continuous process improvement efforts in developing, implementing and documenting all PV training and conventions with regards to case management activities
- Collaborates with team members on the development and implementation of SOPs, process diagrams, meeting charters, data entry guidelines, and coding conventions around ICSR management
- Responsible for day-to-day performance management and recruiting activities as it relates to the PV Specialist position
- Responsible for the creation and/or maintenance of procedures and reference material for staff to be able to perform their job functions in a consistent manner
Qualifications for senior case manager
- Evidence of commitment to continuous professional development
- R.N., B.S.N., RPh or other related bachelor's degree
- 7-10 years’ experience in health care or life sciences industry
- 5 years of experience in pharmacovigilance with direct end to end ICSR/Case management experience
- Experience with safety databases required (Argus or related system required)
- Strong knowledge of GvP regulation and documentation requirements
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Senior Case Manager Job Description
Job Description Example
Our company is searching for experienced candidates for the position of senior case manager. 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 senior case manager
- Plays the role of mentor to others, lead process improvements
- Contributes to inspection readiness planning
- Conducts monthly audits of a specific office to ensure all program operations comply with the Quality Control Plan and contractual obligations
- Assess the current position on each account in your portfolio/ workload in relation to balance, arrears, payment history and customer engagement to date
- Lead medium to large ECM projects that impact other applications and technologies
- Analyze, design, and develop IBM Case Manager solutions to replace paper intensive business processes
- Work with analysts to gather requirements, write technical design documents, develop solutions, test, debug, and implement projects
- Perform complex assignments independently, , in large team settings
- Work with outside vendor teams that interface with our internal applications
- Provide development estimates based on project scope
Qualifications for senior case manager
- Ability to prioritize work and ensure all compliance elements are met
- Transformational Leadership Skills including an awareness of team dynamics and functioning
- 3 years of experience in pharma/biotech highly preferred
- 3 years’ staff management highly preferred
- Proficient in use of safety database
- Functional and technical understanding of other pharmacovigilance systems and tools
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Senior Case Manager Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of senior case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for senior case manager
- Enjoy multi-tasking and working in a fast paced environment
- Assist with training and mentoring less experienced staff
- Presents services and commits site to the program
- Customizes program elements to meet the needs of assigned top prescribing physicians
- Initiate and respond to inquiries about leave and disability events, benefits, and options available to employees
- Critically assess and adjust the case management plan to an employee’s changing needs
- Troubleshoot issues and seek to remove barriers before, during, or after a leave event
- Respond to employee impacting issues that may arise during the leave event and ensure the right communication occurs
- Identify and solve problems that may arise, sometimes with limited information
- Facilitate a smooth return to work and ramp-back plan for employees returning to the workplace
Qualifications for senior case manager
- In-depth knowledge of coding conventions and dictionaries
- Detailed understanding of pharmacovigilance processes and requirements
- Basic understanding of drug development processes and activities
- Basic understanding of core systems used in Regulatory and Clinical
- Solid understanding of medical concepts, terms, and conditions
- Understands basic concepts of clinical pharmacology and toxicology as applied to pharmacovigilance
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Senior Case Manager Job Description
Job Description Example
Our growing company is hiring for a senior case manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for senior case manager
- Assessing contribution refund and reclassification requests
- Dealing with and making a technical analysis of adverse, contested and complex claims (especially disputed claims - SCT/Litigated)
- Maintenance of team procedure guides / policies and template documents
- Review of PDS/Product communications and Standards
- Tracking and monitoring of team service standards
- Team training and maintaining knowledge of compliance and regulatory requirements
- Proactively communicates with customers and authorized third parties to ensure, based upon facts presented at the time, understanding of all potential outcomes at each step of the process
- Ensure all verbal and written communication with the borrower and authorized third parties is in a manner that is simple to understand, empathetic to the borrowers' financial situation, professional, and represents a strong breadth of knowledge
- Collaborates with various support departments within servicing to identify needs, propose innovative solutions and deliver results while meeting deadlines in a professional manner
- Answer incoming calls from homeowners whose mortgage payments are delinquent and counsel them accordingly, with an understanding that the primary focus is to bring the account current
Qualifications for senior case manager
- High School diploma or equivalen, preferred
- Demonstrated high level customer service
- Experience conducting and documenting patient health insurance benefit investigations, prior authorizations, and appeals, preferred
- Knowledge of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred
- Knowledge of ICD9/ICD10 coding is preferred
- Critical and creative thinking, preferred
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Senior Case Manager Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of senior case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for senior case manager
- Attain delinquency resolution through payment, repayment plans, loss mitigation solicitation and financial interviews as required
- Provide guidance to the SPOC Supervisor by maintaining daily predictive dialer activities
- Maintain knowledge of all applicable investor, agency and insurer requirements for servicing first and second mortgage products and HELOCS
- Support other Case Managers as needed
- Escalates issues timely to applicable channels
- Required to successfully complete annual mandatory training requirements and department specific training, as defined by management
- Provide guidance to the SPOC Supervisor by assisting with Job Aide and QRG introductions
- Proper handling of mortgage delinquencies, loss mitigation, foreclosure and bankruptcy issues as required
- Provide guidance to SPOC Case Managers and SPOC Supervisor to assist the team in meeting established goals, Service Level Agreements and compliance objectives
- Provide guidance to SPOC Supervisor for any monthly monitor reviews and/or feedback
Qualifications for senior case manager
- Clear knowledge of Medicare, Medicaid & Commercial payers policies and guidelines for coverage is required
- Clear understanding of Medicare plans (A, B, C, D)
- Knowledge of DME, MAC practices if preferred
- Must have clear understanding of Medical, Supplemental, and pharmacy insurance benefit practices
- 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience
- 1-2 years’ experience with Prior Authorization and Appeal submissions