A direct hire opportunity is available for a Case Manager / LPN Care Coordinator in Miami, FL. This role is ideal for an experienced Licensed Practical Nurse who wants to use clinical knowledge in a non-bedside, insurance-focused care coordination setting.
If you want to know about the requirements for this role, read on for all the relevant information.
The Case Manager will support insured student members by helping them navigate healthcare services, insurance benefits, claims, referrals, authorizations, and provider access.
Responsibilities
- Conduct outreach calls to insured members to complete basic health assessments, review care needs, and follow up on active cases.
- Coordinate healthcare services for students, including locating appropriate in-network providers, facilities, specialists, DME, and home health resources when needed.
- Review medical records, utilization history, claims activity, benefits, referrals, and prior authorizations to support accurate case management.
- Assist with claims follow-up, eligibility verification, benefit questions, provider network research, and insurance navigation.
- Maintain accurate case notes while ensuring HIPAA compliance and confidentiality of all medical information.
Qualifications
3+ years of experience in health insurance, HMO setting.
Strong medical background with knowledge of medical terminology, clinical workflows, and basic chronic disease management. xzgxqkn
Familiarity with commercial HMO/managed care, including claims, referrals, prior authorizations, and benefits.
Case Manager in coral gables at Unknown Company
This position is listed as full time and onsite.