Care Management Specialist

Community Health Systems; Roswell (NM); On-site; USD 42,000 - 62,000; Full time

Job summary

Community Health Systems in Roswell, NM is seeking a Care Management Specialist to support care coordination, discharge planning, and documentation management. You will collaborate with Care Managers, Social Workers, and physicians to ensure smooth transitions and timely access to resources.

The role emphasizes accurate EMR entries, insurance verification, and communicating with payers to obtain approvals, while upholding HIPAA and hospital policies.

Qualifications

• 1–2 years of care coordination or healthcare administration experience.
• Experience in hospital, insurance, or post-acute care settings preferred.
• Knowledge of HIPAA guidelines.

Responsibilities

• Coordinate discharge planning and referrals for post-hospital care.
• Verify insurance coverage and obtain necessary approvals.
• Maintain accurate EMR documentation of care management activities.
• Communicate with patients and families about discharge instructions and resources.
• Collaborate with home health, DME, SNFs, and post-acute providers.

Skills

Care management

EMR systems

Communication skills

Time management

HIPAA

Tools

EMR software

Job description

Why You’ll Love Working Here:

• Comprehensive Health Coverage – Medical, dental, & vision plans to keep you and your family healthy. Life Insurance is also available.
• Future Security – 401(k) with employer matching to help you build long-term financial stability.
• Educational Assistance – Tuition Reimbursement- because we invest in your future.
• Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication.
• Paid Time Off –Generous paid time off- giving you a good work/life balance and time to recharge.

Role:

Care Management Specialist

Location:

Eastern New Mexico Medical Center- Roswell, NM

Schedule:

Full time- Day Shift

Job Summary

The Care Management Assistant 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.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• 1-2 years of experience in care coordination, case management support, patient access, or healthcare administration preferred
• 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.