Entry-Level Surgical Case Manager — NYC Medical Claims

Chapter 13 Trustee Middle District of Alabama; New York (NY); On-site; USD 42,000 - 62,000; Full time

Job summary

CitiMed in New York is seeking an Entry-Level Surgical Case Manager to coordinate and oversee surgical patients across Workers' Compensation, No-Fault, and Medical Lien cases. The role focuses on securing authorizations, accurate documentation, and timely communication with physicians, carriers, and legal teams.

The ideal candidate will build a career in medical case management in a fast-paced clinical environment, handling pre-authorization through post-operative discharge with attention to

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree in Health Sciences, Healthcare Administration, or related field preferred.
• 0-2 years of experience in a medical office, case management, or healthcare administrative role; WC or NF experience a plus.
• Familiarity with medical terminology, surgical CPT codes, and ICD-10 diagnosis codes preferred.
• Knowledge of the NY Onboard prior authorization portal and NYS Workers' Compensation Board processes is a plus.

Responsibilities

• Manage and track a caseload of surgical patients across WC, NF, and Medical Lien claims from initial evaluation through post-operative care.
• Submit and follow up on Prior Authorization Requests (PARs) for surgical procedures, DME, and post-operative physical therapy through NY Onboard portal and carrier platforms.
• Review and interpret denial letters and utilization review determinations; coordinate with physicians and legal staff to prepare appeal documentation and supporting clinical records.
• Ensure clinical documentation is complete, accurate, and submitted within required timeframes to support authorization and billing.
• Communicate with WC carriers, No-Fault insurers, and lien holders regarding claim status, authorizations, and treatment updates.
• Coordinate scheduling of pre-operative appointments, surgical procedures, and post-operative follow-up visits.
• Liaise with attorneys, adjusters, and third-party administrators on case status, legal holds, and lien resolution as needed.
• Monitor patient compliance with prescribed PT, home exercise programs, and follow-up visits; document and communicate non-compliance as appropriate.
• Maintain organized and up-to-date case files in the practice management system, ensuring all authorizations, denial letters, appeal submissions, and correspondence are properly documented.
• Assist in preparing Statements of Medical Necessity and other supporting documents as directed by the treating provider.

Skills

Strong organizational skills

Excellent written and verbal comms

Collaborative team player

Bilingual (English/Spanish)

Education

Associate's or Bachelor's degree preferred

High School Diploma or GED required

Tools

Microsoft Office

Job description

CitiMed in New York is seeking an Entry-Level Surgical Case Manager to coordinate and oversee surgical patients across Workers' Compensation, No-Fault, and Medical Lien cases. The role focuses on securing authorizations, accurate documentation, and timely communication with physicians, carriers, and legal teams.

The ideal candidate will build a career in medical case management in a fast-paced clinical environment, handling pre-authorization through post-operative discharge with attention to