Care Management Specialist

Job Description

Job Summary 

The Care Management Specialist provides administrative and operational support to the Care Management team, assisting with care coordination, discharge planning, insurance verification, and documentation management. This role works closely with Care Managers, Social Workers, healthcare providers, and patients to ensure a smooth transition of care and timely access to necessary resources. The Care Management Specialist helps facilitate communication, gather patient information, and coordinate services to support optimal patient outcomes and continuity of care. 

Essential Functions

• Assists the Care Management team in coordinating discharge planning, referrals, and follow-up services to support patients’ post-hospital care.
• Communicates with insurance providers, payers, and authorization departments to verify coverage and obtain necessary approvals for care services.
• Maintains accurate documentation of care management activities, ensuring timely entry of notes, referrals, and authorizations into the electronic medical record (EMR).
• Supports patient and family communication, providing general information about discharge instructions, community resources, and follow-up appointments.
• Coordinates with home health agencies, durable medical equipment (DME) providers, skilled nursing facilities, and other post-acute care services to facilitate smooth care transitions.
• Reviews and organizes patient charts, medical records, and required forms to ensure all necessary information is available for care management staff.
• Tracks and follows up on pending authorizations, service requests, and post-discharge care needs, escalating concerns to Care Managers as needed.
• Assists with patient screenings and assessments, ensuring compliance with regulatory guidelines and hospital policies.
• Incorporates age-specific considerations in discharge planning, ensuring patient needs are met appropriately based on developmental and medical factors.
• Supports compliance with CMS, Joint Commission, and other regulatory requirements by maintaining organized and complete documentation.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Associate Degree or higher in Healthcare Administration, Social Work, Nursing, or a related field preferred
• 1-2 years of experience in care coordination, case management support, patient access, or healthcare administration required
• Experience in a hospital, insurance, or post-acute care setting with knowledge of healthcare payers and authorizations preferred

Knowledge, Skills and Abilities

• Knowledge of care management processes, discharge planning, and post-acute care coordination.
• Familiarity with insurance verification, prior authorizations, and healthcare payer requirements.
• Proficiency in electronic medical records (EMR) systems and healthcare documentation practices.
• Strong organizational and time management skills, with the ability to prioritize multiple tasks.
• Excellent communication and interpersonal skills, ensuring effective collaboration with patients, families, and healthcare providers.
• Ability to problem-solve and work independently, escalating complex issues to the appropriate Care Management team members.
• Understanding of HIPAA regulations and patient confidentiality standards.