A direct hire opportunity is available for a Case Manager / LPN Care Coordinator in Miami, FL. This role is ideal for an experienced Licensed Practical Nurse who wants to use clinical knowledge in a non-bedside, insurance-focused care coordination setting.
The Case Manager will support insured student members by helping them navigate healthcare services, insurance benefits, claims, referrals, authorizations, and provider access.
Responsibilities
- Conduct outreach calls to insured members to complete basic health assessments, review care needs, and follow up on active cases.
- Coordinate healthcare services for students, including locating appropriate in-network providers, facilities, specialists, DME, and home health resources when needed.
- Review medical records, utilization history, claims activity, benefits, referrals, and prior authorizations to support accurate case management.
- Assist with claims follow-up, eligibility verification, benefit questions, provider network research, and insurance navigation.
- Maintain accurate case notes while ensuring HIPAA compliance and confidentiality of all medical information.
Qualifications
3+ years of experience in health insurance, HMO setting.
Strong medical background with knowledge of medical terminology, clinical workflows, and basic chronic disease management.
Familiarity with commercial HMO/managed care, including claims, referrals, prior authorizations, and benefits.
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