Case Management Representative

Job description:

• Department: Clinical Operations / Case Management
• Employment Type: Full-time
• Location: Parañaque City – On-site
• Reports to: Clinical Supervisor / Case Management Supervisor

Job Overview

The Case Managemer provides administrative and operational support to the Case Management department by coordinating referrals, tracking patient cases, managing documentation, facilitating communication between healthcare providers, and ensuring timely progression of patients through the continuum of care.

This position is responsible for managing non-clinical case management workflows while maintaining accurate documentation within EMR/EHR systems and coordinating with interdisciplinary teams to support efficient patient care operations.

The Case Management Coordinator works closely with Registered Nurse Case Managers, physicians, healthcare facilities, insurance representatives, Scheduling, Intake, Quality Assurance, and other Clinical Operations teams to ensure timely completion of patient care activities.

Key Responsibilities

• Coordinate assigned patient cases throughout the care continuum.
• Track patient progression and ensure timely completion of required workflow activities.
• Monitor pending physician orders, referrals, authorizations, and required documentation.
• Follow up with physicians, facilities, insurance representatives, and other healthcare providers regarding outstanding requirements.
• Coordinate communication between internal departments and external providers.

• Review patient documentation for completeness and accuracy.
• Upload and maintain documentation within EHR systems.
• Ensure that all required documents are available before RN clinical review.
• Maintain internal tracking logs and case status updates.
• Identify missing or incomplete documentation and coordinate timely follow-up. Care Coordination Support
• Support RN Case Managers by coordinating administrative aspects of patient care.
• Assist with referral processing, authorization tracking, discharge coordination, and continuity of care workflows.
• Coordinate with Scheduling, Intake, Billing, and Quality Assurance teams.
• Escalate clinical questions or documentation requiring nursing judgment to the appropriate RN Case Manager.

• Support RN Case Managers by coordinating administrative aspects of patient care.
• Assist with referral processing, authorization tracking, discharge coordination, and continuity of care workflows.
• Coordinate with Scheduling, Intake, Billing, and Quality Assurance teams.
• Escalate clinical questions or documentation requiring nursing judgment to the appropriate RN Case Manager.

Core Skills

Minimum 2 years combined experience in one or more of the following:

• Case Management
• Care Coordination
• Utilization Management
• Intake / Referral Coordination
• Prior Authorization
• Denials & Appeals
• Healthcare Operations
• US Healthcare BPO

Experience utilizing EMR/EHR systems such as:

• Axxess
• WellSky (Kinnser)
• Home Health MD
• eClinicalWorks

or similar healthcare documentation systems

• Strong EMR/EHR navigation skills
• Excellent documentation management skills
• Strong organizational and time management abilities
• Excellent verbal and written communication
• Ability to manage multiple active patient cases simultaneously
• Strong attention to detail
• Critical thinking and problem-solving skills
• Ability to identify workflow issues and documentation deficiencies
• Ability to prioritize tasks in a fast-paced healthcare environment
• Professional communication and collaboration skills

• Experience supporting US-based healthcare accounts or operations
• Familiarity with Medicare, Medicaid, HMO, or managed care workflows
• Prior exposure to utilization management or authorization workflows
• BPO healthcare or remote clinical operations experience