Utilization & Case Management Specialist

Harboroaks; Fort Wayne (IN); On-site; USD 42,000 - 66,000; Full time

Job summary

Harboroaks is seeking an administrative support specialist for the Utilization department in Indiana. You will handle pre-certification, negotiate continued stays with third-party payers, and gather data to support case management.

The role involves coordinating discharge planning with the clinical team, maintaining the CRM, and presenting case information to payers. It requires collaboration across teams and adherence to performance improvement activities.

Qualifications

• High school diploma or equivalent required.
• Prefer candidates with addiction counseling certification.
• Experience with utilization/case management is a plus.

Responsibilities

• Perform pre-certification and negotiate continued stay with third party payers.
• Gather data to support case management activities and present notes.
• Coordinate discharge planning with clinical team and maintain CRM data.
• Present case information to payers and advocate needs.
• Assist admissions review, concurrent reviews and discharge planning.
• Support physician peer review by gathering data and scheduling.
• Inform management about patient status and document utilization activities.
• Perform other tasks as assigned.

Skills

Administrative support

Data gathering

Payer communications

Discharge planning

Case management support

CRM data management

Interdisciplinary collaboration

Education

High school diploma or equivalent

Tools

CRM software

Job description

Harboroaks is seeking an administrative support specialist for the Utilization department in Indiana. You will handle pre-certification, negotiate continued stays with third-party payers, and gather data to support case management.

The role involves coordinating discharge planning with the clinical team, maintaining the CRM, and presenting case information to payers. It requires collaboration across teams and adherence to performance improvement activities.