Case Manager Job Description template and pdf with duties [2024]

Job summary 1

Case Manager is responsible for the general/comprehensive assessment of needs and coordination of treatment services using a strengths based, trauma informed approach for program participants. Position will also provide direct in-home or in-office behavior management and parenting skills building to program participants.

Duties & Responsibilities 1

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Requirements & Skills 1

Job summary 2

This position performs a variety of case management duties including supervision, referrals for services, preparation of reports and program data maintenance. Position requires a high level of confidentiality.

Duties & Responsibilities 2

Maintains program database and prepares program reports.
Evaluates program participant needs and makes referrals to community resources and service providers as appropriate, or as required by court order.
Assists the Community Corrections Manager as directed in monitoring program design for effectiveness and to meet grant requirements.

Requirements & Skills 2

Requires knowledge normally acquired through the completion of a bachelor's degree in criminal justice, business administration, social services, psychology or a related field, and/or a combination of education, training and work experience which demonstrates the ability to perform.
Two to four years of experience in criminal justice, social services, or related field.
- Interpersonal skills sufficient to effectively communicate with other County personnel/departments, community organizations and the public in situations requiring tact and patience.
- Mental ability to simultaneously handle multiple tasks requiring concentration and attention to detail with frequent interruptions and distractions due to people and/or telephone calls.
- Physical ability to walk for extended periods of time and work in confined spaces. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Job summary 3

A Case Manager maintains primary ownership of cases during the underwriting process which requires engaging in frequent communication and coordination between life insurance agents, life insurance carriers, and internal resources. He is responsible for setting their agent's expectations appropriately and providing a World Class Customer Service experience throughout the process.

Duties & Responsibilities 3

Receives and reviews new insurance applications for missing information, i.e., forms, signatures, policy criteria, etc., prior to submission to the insurance carrier
Conducts regular follow-up via phone primarily and email and/or fax secondarily, on all outstanding underwriting requirements.
Organizes and prioritizes workload to ensure case is processed, issued, and placed in a timely manner while maintaining frequent communication to manage customer expectations appropriately
Maintains internal processing database to document work activity and communication on all assigned cases
Acts as a conduit for all issues associated with a case to include coordination with all internal departments
- May have responsibility for reviewing issued insurance policy for accuracy before mailing to insurance agent
- Follows-up with insurance agents on policy delivery requirements, including application amendments, health statements, insurance premium etc., to ensure policy is placed within specified timeframe
- Taking initiative to review other than applied for offers on term cases to determine if alternatives exist

Requirements & Skills 3

Job summary 4

The Case Manager is responsible for supervising, developing, and facilitating all activities including securing insurance coverage, obtaining and maintaining relationships with healthcare payors, providers and patients.

Duties & Responsibilities 4

Processes requests for prior authorization, including: review requests for completeness, communicate missing information or other follow-up activities to ordering providers and/or patients and facilitates the prior authorization with a diverse group of payors.
Documents all activities with payors, providers, patients and internal departments for all sample requests.
- Adheres to all applicable company and departmental Standard Operating Procedures.
- Supports established partnerships and relationships with payors as well as all healthcare utilization management companies.
- Participates in organizational initiatives related to process development, program management or operational efficiencies.

Requirements & Skills 4

Licensure and certification as required by individual’s degree.
Experience working with insurance required including experience with medical benefits/claims, authorizations and provider appeals and knowledge of ICD-10 and CPT codes.
Familiarity and experience working with payors, 2+ years required.
Excellent communication, interpersonal and analytical skills.
Ability to triage issues appropriately and understand when to escalate concerns.
Excellent judgement and discretion.
- Ability to handle multiple priorities simultaneously, meet deadlines, handle work-related stress is required in a fast-paced, challenging work environment.
- Must be detailed oriented, organized, self-starter, can prioritize workload and have a positive attitude.
- Must be tech-savvy, including intermediate knowledge and experience with Microsoft Windows, Microsoft Office products, Internet and general office equipment.

Job summary 5

The Case Manager will deliver stellar client service to clients while adhering to the highest ethical standards. In a team environment, communicate with clients, insurance companies, medical providers, and law enforcement offices on a regular basis. Take ownership over client files for review with the Attorney and Medical Clerk on a daily basis. Develop each individual case according to office policies and work diligently towards resolving all client matters. Maintain each individual file so that all information is filed into the file and mirrored in our client matter management system and scanned to our document management system.

Duties & Responsibilities 5

Requirements & Skills 5

Job summary 6

The Case Manager provides person centered services to promote recovery of patients. Our goal is to help them obtain and maintain an optimum quality of life that is consistent with the person's needs and preferences. This position requires assessment of the person in the community to help them gain access to medical, social, educational, vocational, and other necessary services connected to the person's health needs.

Duties & Responsibilities 6

Requirements & Skills 6

Job summary 7

The primary purpose of this position is to provide day-to-day case management oversight and coordination of assigned caseload to ensure parties responsible for tasks are completing them timely, as well as act as a primary resource for patients, healthcare providers and field reimbursement. The Case Manager is responsible for ensuring prior authorizations, reauthorizations and appeals are obtained timely, as well as ensuring accurate documentation of payer information and patient status. In addition, the Case Manager is responsible for completing a pre-screen to determine eligibility for additional services such as injection services, co-pay mitigation, and patient assistance programs (PAP), if applicable.

Duties & Responsibilities 7

Requirements & Skills 7

Bachelor’s degree or six years of relevant working experience
Two (2) or more years of relevant experience in pharmacy benefit management preferred
Medical Assistant, Social Worker or Senior Reimbursement Specialist experience preferred
Proficient in MicroSoft Office applications
- Knowledge of medical and claims processing terminology
- Excellent written/verbal communication to include providing clear instructions
- Must possess a strong critical thinking skillset along with the ability to multi-task

Job summary 8

Case Managers accomplish clients' case management by assessing needs; monitoring and evaluation progress, facilitating interaction with multiple service providers; providing continuity throughout program participation; and ensuring clients are engaged and knowledgeable of program.

Duties & Responsibilities 8

Determine clients' eligibility to participate in the program by completing intake interviews, and reviewing records and applications
Coordinating services being provided; arranging resources
Monitoring cases through to completion; obtaining additional resources; intervening in crises; providing personal support to cases as needed
- Maintaining clients' records by compiling case notes; logging events and progress using program software
- Regularly communicating progress by participating in weekly case management reviews
- Preparing cases for close-out by coordinating program requirements

Requirements & Skills 8

High School Diploma or GED
2 years’ work experience in customer-facing jobs requiring communications to both internal and external customers and entities (vendors, etc.)
Excellent English language proficiency in both verbal and written communication
Must possess and demonstrate professional integrity
Must have excellent listening skills and an ability to process and translate customers’ needs identified through intake calls, into individuals management cases for each outward facing customer/resident, with a high attention to detail
- Must possess strong organizational skills, including the ability to document case details consistently, thoroughly, and quickly using program software
- Demonstrated ‘people skills,’ including the ability to interact effectively with the general public, contractors, inspectors, and other service-providers in a professional manner
- Must demonstrate a high attention to customer service in all interactions with public, including maintaining a calm and professional demeanor, and demonstrating the ability to resolve conflict quickly and effectively

Job summary 9

This is a production focused position that will be responsible for managing the application activity through the new business life cycle. The job requires problem solving and research skills, sense of urgency in processing business and coordinating communication surrounding the case activity. A Case Manager must take ownership of individual and team caseloads and service standards through completion of the application process while providing details and consistent communication.

Duties & Responsibilities 9

Performing initial and ongoing review of each application submitted for the customers assigned, through the new business process.
- Managing customer relationships by providing timely response to inquiries, concerns, & requests via email and phone.
- Supporting team initiatives & providing back up support for team members during peak influx times and periods of PTO.
- This position also works very closely with underwriters, vendors, and customers on aging cases to ensure completion within time standards.

Requirements & Skills 9

1-5 years life insurance experience or Bachelors degree in business or related field.
Minimum of six months monitored production work.
Must have excellent verbal and written communication, customer service, problem solving skills, and able to work well within a team.
Must have the ability to meet the needs of a diverse customer group and deal with difficult customers.
Must have good listening skills; must learn to listen to the customer to determine and learn basic probing questions to ask, using a logical and problem solving mindset.
- Must adapt easily to a quick changing environment.
- Assumes ownership of individual and team caseloads and service standards throughout completion of the application process while providing detailed and consisten communication to the customer.
- Maintaining productivity & quality at or above the team standard.

Job summary 10

This position manages a caseload of participant cases by administering the policies and procedures of the program as directed by the contracting agency and the Program Manager or Supervising Case Manager. Learns, uses and models principles of the “What Works” system through evidence-based practices in all interactions with participants and other staff members.

Duties & Responsibilities 10

To learn and develop proficiency in Client Services Specialist’s duties, including opening and closing the office, and performing participant intakes, check-ins, breath analysis and drug screens, to provide backup when necessary.
Manages a participant caseload using principles of the “What Works” system. Conducts risk/need assessments and creates individual treatment plans for each assigned participant. Meets regularly with participants and documents participants’ progress or regress in Company database.
Conducts orientation meetings with new participants to explain program rules and regulations. Verbally explains the participant contract in detail to ensure that the participant understands his/her responsibilities.
Sets participant schedules and specifies all approved activities based on sentencing information. Approves temporary schedule changes for approved activities.
Monitors participant compliance with all outside treatment or community connection referrals.
Reports all program violations to the appropriate agency or official via the established reporting parameters.
- Reports on the status of program operations regularly to ensure all necessary documentation is prepared for court review.
- May facilitate psycho-educational/behavior modification groups each week. Documents participants’ attendance, participation and progress in Company database.
- May testify in court regarding participants’ compliance with court orders.

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