Medical Case Manager

Care Resource Health Centers, Inc.; Miami (FL); On-site; USD 40,000 - 60,000; Full time

Job summary

Care Resource Community Health Centers, Inc. is seeking a dedicated professional to provide outreach and enrollment assistance for health insurance, Medicaid, and CHIP. You will interview clients, determine eligibility, enroll in programs, and coordinate medical treatments while maintaining comprehensive patient records.

The role requires a bachelor’s degree in a behavioral science field, two years of related experience, and relevant HIV/AIDS training. Some travel and home visits may be involved.

Qualifications

• Bachelor’s degree in behavioral science field required.
• Two years of related experience required; HIV/AIDS experience preferred.
• HIV/AIDS 104, 500 & 501 and Case Management training within 90 days of hire.
• ACA Certified Application Counselor certification annually; Case Management Medicaid Provider Certification required.
• Own transportation required.

Responsibilities

• Provide outreach and enrollment assistance for health insurance marketplaces, Medicaid, or CHIP.
• Interact with clients to improve health and enroll into services.
• Create rapport to support medical treatment progress for clients.
• Interview prospective clients to determine eligibility for medical or social services and enroll in programs.
• Coordinate, support and follow up on medical treatments and maintain active caseloads.
• Serve as liaison between departments and external providers to remove barriers to care.
• Conduct home or hospital visits to assess acuity of care and coordinate service mobilization.
• Discharge planning from hospitalizations and coordinate post-hospital care.
• Maintain records of labs, medications, testing, visits, and treatment plans to ensure compliance.
• Provide ongoing medication and treatment counseling and monitor treatment adherence.

Education

Bachelor’s degree in behavioral science field (Social Work, Nursing or Psychology)

Job description

Provide outreach and enrollment assistance activities and facilitates enrollment of eligible health center patients and service area residents into affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, or the Children’s Health Insurance Program.

Interactions with clients that lead to improved client health.

Create rapport with client interactions to help each progress in their medical treatment.

Interview prospective clients to determine individual needs and eligibility for various medical or social services and enroll them into available community programs.

Coordinate, support and follow up on medical treatments.

Maintain an average annual active caseload assigned by the supervisor.

Serve as a liaison, coordinator and/or advocate between various co-workers within the Case Management, Medical Care departments or other community medical or agency service providers to remove barriers to treatment/care for clients.

Use knowledge of individual programs to conduct home visits, hospital visits and one visit with the State of Florida’s contracted disease management firm to develop acuity level of care as needed.

Coordinate with physicians for appropriate service mobilization.

Discharge planning from hospitalizations that assist with coordinating post hospital care based upon client needs.

Maintain organized systems of tracking client labs, medication, diagnostic testing, medical, therapy and hospital visits to help clients remain compliant with treatment and service plans; all with the goal of seeing clients progress toward improvements in their lives.

Provide ongoing medication and treatment counseling through use of treatment adherence assessment tools.

Treatment and Service Planning and Documentation:

Ensure all documentation is timely, accurate, legible and clear.

Develop comprehensive, individualized service plans or plans of care.

Monitor clients to assess efficacy of treatment plans and reassess and adjust as necessary.

Empower clients to participate in their treatment planning.

Maintain treatment plans, progress notes and progress reviews in client records as specified in agency policy, program guidelines and performance standards.

Input client information using electronic data entry according to agency and departmental guidelines.

Maintain an accurate record on time sheet reflecting time spent in each program worked (e.g. Ryan White 75 hrs, Medicaid Waiver 5 hrs, ACA 10 hrs).

Prepare necessary program reports and records as requested by the supervisor and/or manager.

Coordinate with supervisor when necessary to meet unusual challenges.

Manage Resources:

Maintain comprehensive knowledge of community services to apply knowledge of services to individual client needs.

Utilize knowledge of community programs to help clients understand the different types of medical, insurance and other programs offered under State and Federal Programs as required.

Bill a minimum of six hours in an 8-hour day.

Use program knowledge to provide clients with information about bill-coverage, services and procedures as required.

Control, manage, and balance the monthly and annual budget stipulated by the State of Florida for each appropriate client.

Support billing through concurrent documentation of service provided and budget activities as required (i.e. reconciling billing across data systems including: PCIS, Web-based systems, CASEWATCH and client records).

Participate in staff training sessions within the timeframes specified and as required by the agency and the funding source.

Community Involvement:

Participate in agency developmental activities as requested.

Other duties as assigned.

Safety

Ensure proper hand washing according to Centers for Disease Control and Prevention guidelines.

Documents patient’s medications correctly, makes sure each patient knows which medicines to take when they are at home and encourages each

patient to bring their up-to-date list of medicines every time they visit the doctor.

Ensures each new client receives screening for their risk of suicide.

Understands and appropriately acts upon assigned role in Emergency Code System

Understands and performs assigned role in Agency Continuity of Operations Plan (COOP)

JOB SPECIFICATIONS

Education:

Bachelor’s Degree in a behavioral science field like Social Work, Nursing or Psychology is required.

Training and Experience:

Two (2) years of related experience are required. One year of HIV/AIDS experience is required. HIV/AIDS 104, 500 & 501 and Case Management training provided by the State or County are required within 90 days of hire date.

Licenses and/or certifications:

Affordable Care Act Certified Application Counselor Certificate required annually. Case Management Medicaid Provider Certification is required. Completed application and fingerprinting submitted to supervisor within 30 days of hire.

Contact Responsibility:

The responsibility for internal and external contacts is frequent and important.

Culture of Service: 3 C’s

Compassion

Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.

Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.

Competency

Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered

Commitment

Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed

Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided

Physical Requirements

This work requires the following physical activities: constant sitting, walking, hearing, talking in person and talking on the phone. Occasional driving stretching/reaching and standing are required. Work is performed in an office setting. Sometimes, work is performed in client’s homes, community agency settings and in hospitals.

Other

Participates in health center developmental activities as requested. Other duties as assigned. Own transportation required.

Legal Compliance Notice: This careers website is maintained by Care Resource Community Health Centers, Inc. a qualified entity, in support of compliance with House Bill 531 (2025). As required by law, Care Resource includes a clear and conspicuous link to this resource on its website and provides the link in all job vacancy advertisements and postings issued by the health center. For more information, please see the link to the new Care Provider Background ScreeningClearinghouse Education and Awareness website.

Enthusiastic : Shows intense and eager enjoyment and interest

Dedicated : Devoted to a task or purpose with loyalty or integrity

Team Player : Works well as a member of a group

Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Required

Flexibility : Inspired to perform well when granted the ability to set your own schedule and goals

Ability to Make an Impact : Inspired to perform well by the ability to contribute to the success of a project or the organization

Education

Required

Bachelors or better in Social Work or related field.

Experience

Required

2 years: Two years of related experience are required. One year of HIV/AIDS experience is required. HIV/AIDS 104, 500 & 501 and Case Management training provided by the State or County are required within 90 days of hire date.

Licenses & Certifications

Required

ACA Certified

Equal Opportunity Employer
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