Clinic Managed Care, Case Manager

Paycom - ATS; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

Paycom - ATS is seeking a Clinic Managed Care Case Manager to coordinate care for patients in managed care programs and close care gaps. The role collaborates with providers, clinic staff, and health plans to ensure timely, high-quality outcomes.

Responsibilities include outreach, wellness initiatives, referrals, and transitions of care. Strong RN/LVN background and knowledge of EHR systems are preferred to support efficient care delivery.

Qualifications

• LVN or RN preferred; healthcare experience may be considered.
• Experience in primary care, case management, managed care, or population health preferred.
• Knowledge of chronic disease management and preventive care.
• Strong communication and organizational skills.
• Ability to work independently and collaborate with providers and clinic teams.

Responsibilities

• Coordinate care and follow-up for managed care patients.
• Identify and assist with closing quality and preventive care gaps.
• Conduct patient outreach for appointments, screenings, and follow-up care.
• Assist with annual wellness visits and chronic care initiatives.
• Review payer reports and patient lists to identify patients needing intervention.
• Coordinate referrals and specialty care when needed.
• Follow up with patients after hospital or emergency room visits.
• Assist with transitions of care and chronic care management activities.
• Communicate patient needs and barriers to providers and clinic staff.
• Document outreach, interventions, and outcomes in the medical record.
• Assist with HEDIS, quality, and managed care initiatives.
• Educate patients regarding their care plan and recommended follow-up.

Skills

Care coordination

Communication

Organization

Teamwork

Quality improvement

Confidentiality

Education

LVN or RN license preferred

Tools

Electronic Health Records

Microsoft Office

Job description

Position SummaryThe Clinic Managed Care Case Manager supports patients enrolled in managed care programs by coordinating care, addressing gaps in care, and assisting with follow-up needs. This position works closely with providers, clinic staff, patients, and health plans to improve quality outcomes and ensure patients receive appropriate and timely care.Essential DutiesCoordinate care and follow-up for managed care patients.Identify and assist with closing quality and preventive care gaps.Conduct patient outreach for appointments, screenings, and follow-up care.Assist with annual wellness visits and chronic care initiatives.Review payer reports and patient lists to identify patients needing intervention.Coordinate referrals and specialty care when needed.Follow up with patients after hospital or emergency room visits.Assist with transitions of care and chronic care management activities.Communicate patient needs and barriers to providers and clinic staff.Document outreach, interventions, and outcomes in the medical record.Assist with HEDIS, quality, and managed care initiatives.Educate patients regarding their care plan and recommended follow-up.Perform other duties related to managed care and clinic operations as assigned.QualificationsLVN or RN preferred; healthcare experience may be considered based on position requirements.Experience in primary care, case management, managed care, or population health preferred.Knowledge of chronic disease management and preventive care.Strong communication and organizational skills.Ability to work independently and collaborate with providers and clinic teams.Basic knowledge of electronic health records and Microsoft Office.Key CompetenciesPatient-centered care • Care coordination • Communication • Organization • Teamwork • Quality improvement • Confidentiality