Case Management Specialist, Case Management, FT, 8:30A-5P

Baptist Health; Homestead (FL); On-site; USD 26,000 - 34,000; Full time

Job summary

Baptist Health is seeking a Care Management Coordinator to join our team in Florida. This role coordinates information between the Care Management Department and third-party payors, ensures timely utilization reviews, and serves as the liaison with insurance companies to secure appropriate reimbursement.

You will work with Access Management and Patient Financial Services to ensure accurate submissions and support operational initiatives with regular reports and data analyses.

Qualifications

• Associates degree required.
• Bachelor's degree preferred or a combination of relative work experience.
• Administrative experience.
• Advanced computer knowledge including PowerPoint, MS Office and Excel.
• Ability to operate office equipment and learn new software.
• Excellent verbal and written communication and interpersonal skills.
• Multitasking, planning, critical and independent thinking.
• Healthcare regulatory agency experience preferred.

Responsibilities

• Coordinate information between Care Management and Third Party Payors to enable timely submissions.
• Submit utilization reviews to ensure proper reimbursement and prevent denials.
• Liaise between insurance companies and the Care Manager in response to requests for clinical reviews/authorizations.
• Maintain effective relationships with insurance companies through ongoing communication.
• Collaborate with Access Management and Patient Financial Services to ensure accurate submissions for reimbursement.
• Assist with staffing schedules, payroll, inventory management, purchasing and invoicing.
• Provide regular informational reports and data analyses for utilization review management.

Skills

Administrative experience

Verbal & written communication

Interpersonal skills

Multitasking

Planning

Critical thinking

Independent thinking

Education

Associates

AA (Associate of Arts)

Bachelor's degree preferred

Tools

PowerPoint

MS Office

Excel

Job description

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 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 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 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.

Benefits

At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:

• Career growth and development opportunities, with clear pathways and ongoing support
• Comprehensive health and wellness resources that go beyond traditional benefits
• A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
• Tuition reimbursement to support continued learning and advancement
• And so much more

Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.

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. Estimated pay range for this position is $19.83 - $25.18 / hour depending on experience.

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: 4 Years

EOE, including disability/vets