Surgical Case Manager / Surgical Coordinator

CitiMed; New York (NY); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Hands-on training in case management

Exposure to multi-specialty surgical practice

Opportunities for growth

Competitive compensation

Job summary

CitiMed is seeking a detail-oriented Entry-Level Surgical Case Manager to support surgical patients across Workers' Compensation, No-Fault, and Medical Lien cases. The ideal candidate should possess strong organizational and communication skills, with 0-2 years of relevant experience.

The role involves managing a caseload, coordinating care, handling authorizations, and ensuring compliance while working in a multi-specialty clinical environment. Opportunities for growth and competitive compensation are offered.

Qualifications

• 0-2 years of experience in a medical office, case management, or healthcare administrative role.
• Experience with Workers' Compensation or No-Fault cases is a plus.
• Knowledge of NY OnBoard prior authorization portal and NYS Workers' Compensation Board processes.

Responsibilities

• Manage and track a caseload of surgical patients across various claims.
• Submit and follow up on Prior Authorization Requests for surgical procedures.
• Review and interpret denial letters and coordinate appeal documentation.
• Ensure clinical documentation is complete and submitted on time.
• Coordinate scheduling of pre-operative appointments and surgical procedures.

Skills

Organizational skills

Excellent written and verbal communication

Familiarity with medical terminology

Proficiency in Microsoft Office

Education

High school diploma or GED required

Associates or Bachelor's degree in Health Sciences or related field preferred

Tools

Microsoft Office

Practice management or EMR software

Job description

CitiMed is seeking a detail-oriented and organized Entry‑Level Surgical Case Manager to support the coordination and oversight of surgical patients across Workers' Compensation (WC), No‑Fault (NF), and Medical Lien cases. This role is ideal for a motivated individual looking to build a career in medical case management within a fast‑paced, multi‑specialty clinical environment. The Surgical Case Manager will work closely with treating physicians, physician assistants, billing staff, attorneys, and insurance carriers to ensure timely authorization, documentation, and continuity of care for surgical patients from pre‑authorization through post‑operative discharge.

Key Responsibilities

• Manage and track a caseload of surgical patients across Workers' Compensation, No‑Fault, 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 the NY OnBoard portal and carrier‑specific 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 Workers' Compensation 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 tasks.
• Liaise with attorneys, adjusters, and third‑party administrators on case status, legal holds, and lien resolution as needed.
• Monitor patient compliance with prescribed physical therapy, home exercise programs, and follow‑up appointments; 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.

Qualifications

• High school diploma or GED required; Associates or Bachelors 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; experience with WC or NF cases 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.
• Strong organizational skills with the ability to manage multiple cases simultaneously and meet deadlines.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office (Word, Excel, Outlook); experience with practice management or EMR software preferred.
• Ability to work collaboratively with clinical, administrative, and legal teams.

What We Offer

• Hands‑on training in Workers' Compensation, No‑Fault, and Medical Lien case management.
• Exposure to a high‑volume, multi‑specialty surgical practice.
• Opportunity for growth within CitiMed's expanding case management and administrative team.
• Competitive compensation commensurate with experience.

CitiMed is an equal opportunity employer. We are committed to building a diverse and inclusive workplace.