Overview
The Case Manager plays a vital role in supporting patients across multiple specialties by coordinating care, facilitating access to services, and ensuring continuity throughout the healthcare journey. Working under the direction of the Director of Clinical Quality, this position helps bridge gaps in care, reduce barriers, and promote patient-centered outcomes.
Qualifications
- Active Licensed Practical Nurse (LPN) license in the state of Georgia.
- 2+ years of experience in outpatient care coordination, case management, or nursing.
- Familiarity with EMR systems and documentation standards.
- Experience in a multi-specialty or community health setting.
- Knowledge of Medicaid/Medicare and commercial insurance processes.
- Excellent communication, organizational, leadership and customer service skills.
- Excellent phone etiquette.
Responsibilities
- Assess patient needs and develop individualized care plans in collaboration with providers and clinical teams.
- Coordinate referrals, follow-ups, and transitions between specialties and external services.
- Monitor patient progress and proactively address gaps in care or barriers to treatment.
- Maintain accurate and timely documentation in the Electronic Health Record (EHR).
- Ensure compliance with federal, state, and organizational guidelines, including company and regulatory standards.
- Track and report patient outcomes, service utilization, and care plan adherence.
- Serve as a liaison between patients, providers, referral coordinators, and external agencies.
- Participate in department team meetings to review complex cases and align care strategies.
- Communicate effectively with patients to provide education, support, and advocacy.
- Assist in collecting and analyzing data related to care coordination and patient outcomes.
- Support quality improvement initiatives led by the Director of Clinical Quality.
- Contribute to departmental goals by working referral, prior authorization, and refill queues in the EHR when needed.
- Conduct patient intake and clinical triage, assessing presenting concerns, and promptly consulting with providers when expanded clinical guidance or urgent care decisions are needed.
