Case Management Specialist, Care Coordination, Bethesda East, FT, 08:30A-5P Hybrid

Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients’ shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we’re all in.

Description

Is responsible for the coordination of information between the Care Management Department and Third Party Payors (Insurance Companies). Assures timely submission of utilization reviews for the hospital in order to effect proper reimbursement from insurance Companies and prevent denials. Is the departments liaison between insurance companies and the Care Manager in response to insurance requests for clinical reviews/authorizations. Maintains effective working relationships with insurance companies through ongoing communication and collaboration. Works in conjunction with Access Management and Patient Financial Services to assure accurate and timely submission of clinical reviews for appropriate reimbursement. Directs any potential denials to the Denials Coordinator and assists with the submission of missing documentation to insurance companies when necessary. Responsible for key business functions including creating and maintaining staffing schedules, managing payroll, inventory management, purchasing and invoicing. Uses effective communication skills to provide support in disseminating information to the staff. Supports operational initiatives and projects providing regular informational reports analysis and organizing data for utilization review management.

Qualifications

Degrees:

• Associates.
  
  

Additional Qualifications

• Associate of Arts - AA required.
• Bachelors degree preferred and/or a combination of relative work experience preferred.
• Administrative experience.
• Advance computer knowledge including Power Point, MS Office and Excel.
• Ability to operate office equipment and expand knowledge and learn new software.
• Excellent verbal and written communication and interpersonal skills.
• Must be skilled in multi-tasking, planning, critical and independent thinking.
• Able to achieve results through influencing and able to maximize efficiencies while supporting fast pace work environment which may include multiple locations and leaders.
• Experience with healthcare regulatory agencies preferred.
  
  

Minimum Required Experience

• Associate's degree required
• 4 years of minimum administrative experience preferably within a healthcare setting
• Advance computer knowledge including Microsoft Office: Power Point and Excel
  
  

EOE, including disability/vets