Medical Insurance Program Case Manager

Job Description

Job Description

POSITION TITLE: MEDICAL and INSURANCE PROGRAM CASE MANAGER

LOCATION: Big Bend Cares

DEPARTMENT: Client Services

TYPE OF POSITION: Full-time (Monday-Friday 8:00 a.m. to 5:00 p.m.)

GENERAL FUNCTION: The Medical and Insurance Program Case Manager provides social work and client advocacy services to clients of Big Bend Cares and reports to the Director of Client Services.

JOB REQUIREMENTS:

Assists HIV positive clients with improving their health by providing client-centered activities, including:

• Conducting annual comprehensive eligibility determinations.
• Assessing service needs and developing comprehensive, individualized care plans.
• Providing timely and coordinated linkage and access to core medical and support services.

• Enrolling Insurance Program participants in compliance with program requirements.

• Coordinating with Chief Pharmacy Officer on Insurance Program premiums and 340B rebates.
• Educating Insurance Program clients about responsibilities, including payments schedules, and providing support to ensure timely payment.
• Collecting Insurance Program client payments toward premiums, co-pays, and other patient-responsible portions and actively following up to secure payments.

• Monitoring client progress and re-evaluating care plans.
• Following DOH’s HIV/AIDS case management standard and guidelines including those outlining required eligibility redeterminations, use of CAREWare, and casefile documentation.
• Maintaining a thorough knowledge and understanding of the Clients’ Rights and Responsibilities as well as all client services procedures.
• Advocating on each client’s behalf in accessing needed services.
• Recommending changes in case management policies and procedures.
• Completing pre-intakes as required.
• Maintaining and reporting caseload data as requested.
• Maintaining assigned client files.
• Completing billing documentation.
• Performing other duties as assigned.

QUALIFICATIONS:

• Case managers must have at least one of the following staff qualifications:

• A bachelor’s degree in psychology, social work, or human services,
• A bachelor’s degree in any field of study with at least six months of case management experience,
• Applicable experience, which may be substituted on a year-for-year basis for the required education, or
• A registered nursing license in Florida.
• Must submit to and pass a level 2 background screening.
• Must have reliable transportation.

PREFERRED QUALIFICATIONS:

• Knowledge of HIV disease, government programs, and medical social work procedures.
• Knowledge of health insurance assistance programs (e.g., ADAP, marketplace, COBRA, Medicaid).
• Experience with benefits coordination, insurance premium assistance, or billing reconciliation.
• Familiarity with 340B program principles and insurance payment interactions.

EOE/ADA