Case Manager

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. Familiarity with commercial HMO/managed care, including claims, referrals, prior authorizations, and benefits.