Case Coordinator

• Evaluate members using care management assessments and information/data review
• Recommend approaches to resolve care needs and maintain optimal health and well-being
• Identify high-risk factors and service needs affecting member outcomes
• Implement proactive support interventions and coordinate Wellness care plan activities
• Monitor member care needs
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use motivational interviewing to engage members and promote lifestyle and behavior changes
• Coach and educate members to support independent medical and healthy lifestyle choices
• Help members participate knowledgeably in healthcare decision-making with providers
• Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements

Aetna Better Health case coordinator supporting Kentucky youth and families through behavioral-health care management

Intensive Case Management Coordinator - Field

Aetna Better Health case coordinator supporting Kentucky youth and families through behavioral-health care management. Evaluating needs, coordinating care plans, and engaging members across Jefferson County.

• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
• Recommend case-resolution approaches by evaluating benefit plans and internal and external programs or services
• Identify high-risk factors and service needs affecting member outcomes and care planning
• Make appropriate referrals and coordinate assigned care-plan activities
• Monitor care-plan progress
• Use a holistic approach to overcome barriers and meet goals and objectives
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues through established channels
• Negotiate appropriate options and services to meet members’ benefit and healthcare needs
• Use influencing and motivational-interviewing skills to engage members and promote lifestyle or behavior changes
• Provide coaching, information, and support for independent medical and healthy-lifestyle choices
• Support members in participating knowledgeably in healthcare decisions with providers
• Apply case-management processes in compliance with regulatory, accreditation, and company requirements
• Coordinate, document, and communicate aspects of the utilization and benefit-management program

CVS Health case management coordinator supporting Pima County members through care coordination and health education

Case Management Coordinator

CVS Health case management coordinator evaluating member needs and coordinating care for Pima County communities.
Providing education, referrals, care planning, and quality-of-care support from home with local travel.

• Coordinate patient care plans and ensure timely implementation of services.
• Conduct assessments and facilitate communication between patients and healthcare providers.
• Monitor patient progress and adjust care plans as necessary.
• Maintain accurate and up-to-date patient records and documentation.
• Collaborate with multidisciplinary teams to optimize patient outcomes.
• Provide education and support to patients and their families regarding care options.
• Assist with discharge planning and follow-up care coordination.
• Stay informed about community resources and services to assist patients effectively.

Case Management Coordinator improving patient care for MedPOINT Management, a healthcare management company

Case Management Coordinator coordinating patient care plans and follow-up services for MedPOINT Management, a healthcare management company. Supporting patients, families, and healthcare providers to improve health outcomes.

• Evaluate members’ needs and eligibility using care management tools, information, and data review
• Recommend approaches to case resolution and meeting member needs by evaluating benefit plans and available programs and services
• Identify high-risk factors and service needs and refer members to clinical case management or crisis intervention when appropriate
• Coordinate and implement assigned care plan activities and monitor progress
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome care barriers
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues through established channels
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use influencing and motivational interviewing skills to engage members and promote lifestyle and behavior changes
• Coach, inform, and support members in making independent medical and healthy lifestyle choices
• Help members participate knowledgeably with providers in healthcare decision-making
• Participate in team meetings and provide peer mentoring/training
• Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements

CVS Health case management coordinator supporting complex Aetna members in Winnebago County

Case Management Coordinator – Field

CVS Health case management coordinator supporting Aetna members with complex health and social needs in Winnebago County. Coordinating care plans, benefits access, referrals, and member engagement.

• Evaluate members’ needs and eligibility using care management tools and data review
• Recommend case-resolution approaches based on benefit plans and available programs/services
• Identify high-risk factors and service needs, referring appropriately to clinical case management or crisis intervention
• Coordinate and implement assigned care-plan activities and monitor progress
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues
• Negotiate appropriate options and services for members’ benefit and healthcare needs
• Use influencing and motivational interviewing skills to engage members and promote healthy lifestyle changes
• Provide coaching, information, and support for independent medical and lifestyle choices
• Support members in participating knowledgeably in healthcare decisions with providers
• Participate in team meetings and provide peer mentoring/training
• Monitor and document care using case-management and quality-management processes compliant with regulatory, accreditation, and company requirements

CVS Health case management coordinator supporting member care across Cook County, Illinois

Case Management Coordinator – Field, Illinois

CVS Health case management coordinator supporting member care across Cook County, Illinois. Evaluating needs, coordinating care plans, and helping members access healthcare benefits and services.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
• Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
• Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
• Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans.
• May identify, initiate, and participate in on-site reviews.
• Serves as member advocate through continued communication and education.
• Promotes enrollment in care management programs and/or health and disease management programs.
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
• Performs medical or behavioral review/authorization process.
• Ensures coverage for appropriate services within benefit and medical necessity guidelines.
• Utilizes allocated resources to back up review determinations.
• Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
• Participates in data collection/input into system for clinical information flow and proper claims adjudication.
• Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).

Case Management Coordinator focused on improving care coordination at BlueCross BlueShield.

RN Case Management Coordinator, Maternity/NICU

Case Management Coordinator focused on improving care coordination at BlueCross BlueShield. Responsibilities include care assessments, planning, monitoring services, and advocacy for patients.

• Utilizes critical thinking and judgment to collaborate and inform the case management process
• Facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources
• Conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Engages with colleagues in ongoing team meetings and offers peer mentoring/training
• Helps member actively and knowledgably participate with their provider in healthcare decision-making
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Case Management Coordinator supporting dual eligible populations for Aetna

Field Case Management Coordinator

Case Management Coordinator supporting dual eligible populations in healthcare by collaborating with members, providers, and community organizations. Utilizing critical thinking to improve healthcare outcomes while working remotely.

• Utilizes critical thinking and judgment to collaborate and inform the case management process
• Facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling
• Identifies high risk factors and service needs to impact member outcomes and care planning
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Consults with case managers and Medical Directors to overcome barriers to meeting goals
• Engages with colleagues in ongoing team meetings and offers peer mentoring/training

Case Management Coordinator coordinating healthcare outcomes for members in Cook County

Case Management Coordinator facilitating healthcare outcomes for members in Cook County, Illinois. Collaborating with case managers and utilizing critical thinking skills to inform the case management process.

• Utilize critical thinking and judgment to collaborate and inform the case management process
• Facilitate appropriate healthcare outcomes for members by aiding with appointment scheduling
• Identifying and assisting with accessing benefits and education for members through the use of care management tools and resources
• Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Consult with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Case Management Coordinator facilitating healthcare outcomes for Aetna members

Case Management Coordinator, Assessor Team

Case Management Coordinator at CVS Health facilitating healthcare outcomes for Aetna members. Utilizing critical thinking and judgment to collaborate in the case management process.

• Comfortable managing active caseload of (100-150) cases
• Grow relationship with law firms and medical providers
• Communicate effectively with attorneys, clients and medical providers to ensure best care and best service possible.
• Effectively oversee medical treatment for accident victims, including but not limited to scheduling and coordinating appointments, analyzing medical records and arranging transportation.
• Assess and make funding decisions up to $25K
• Maintain workflow through prioritization of daily and weekly tasks
• Perform weekly metrics by reviewing dashboards, verifying data, and noting basic trends to support accurate case tracking.
• Collaborate with internal stakeholders to ensure service levels and revenue goals are met.
• Occasionally assist with training new team members.
• Provide the best customer service daily.

Case Coordinator role managing funding decisions and coordinating care for accident victims.

Case Coordinator at Libra Solutions managing cases for personal injury clients. Overseeing medical treatment and fostering relationships with law firms and providers in a remote work environment.

• Coordinate client appointments, schedules, aftercare planning, and treatment-related meetings.
• Monitor client progress and collaborate with the treatment team to address emerging needs.
• Develop, facilitate, and monitor individualized care plans.
• Conduct client and family orientations alongside clinical staff.
• Provide ongoing case management support to clients and families.
• Connect clients with community resources, healthcare providers, transportation services, and aftercare support.
• Ensure clients have access to a full continuum of traditional and non-traditional services.
• Assist with referral coordination and provider communication throughout treatment.
• Support recovery engagement initiatives using assessment data and individualized client needs.
• Verify completion of admission documentation, consents, and required records.
• Maintain accurate client records and documentation in accordance with federal, state, and accreditation standards.
• Protect confidential client information and maintain HIPAA compliance.
• Communicate regularly with referral sources, community providers, family members, legal representatives, employers, and internal treatment teams.
• Participate in treatment team meetings and case reviews.
• Collaborate with outreach and marketing teams to strengthen community provider relationships.

Remote Case Coordinator providing client care coordination and support

Remote Case Coordinator managing behavioral health and addiction recovery for clients. Coordinating care and advocating for individuals in their recovery journey with Pyramid Healthcare.

• Conduct comprehensive quarterly evaluations of maternal mortality cases to identify systemic biases and assess how social determinants of health impacted patient outcomes.
• Collaborate closely with Records Analysts and Project Coordinators to translate clinical findings into structured, impactful case narratives for quarterly leadership reviews.
• Finalize and integrate the informant interview toolkit—including outreach letters, standardized scripts, and interview frameworks—into the program's official procedural guidelines.
• Design, record, and deploy a comprehensive training curriculum (via Microsoft Teams) to instruct Records Analysts on conducting sensitive informant interviews, refining modules based on analyst feedback.
• Partner with program administrators and data analysts to evaluate historical Florida case data, utilizing qualitative methods to pinpoint patterns of bias in healthcare delivery.
• Author executive summary reports and design visual reference guides to help clinical abstractors accurately identify bias in medical records.
• Provide direct, hands-on support to the analyst team during quarterly informant interviews, ensuring accurate and timely data entry into program systems.
• Actively participate in all recommended and required programmatic training sessions.

Perinatal Case Coordinator supporting maternal healthcare initiatives at WiredPeople, Inc.

Perinatal Case Coordinator

Perinatal Case Coordinator at WiredPeople, Inc. evaluating maternal healthcare delivery and collaborating on public health programs in Florida.

• An ECM Coordinator III supports department staff with administrative tasks related to a member’s medical condition(s), department case work, communication with internal and external stakeholders, and manage audits.
• This role will engage with members to offer support and resources related to their medical condition(s) through Allied Care.
• Facilitate reviews, referrals, and outreach for referral-based proprietary strategies as well as engaging with members across Medical Management products.
• Document all engagement accurately and concisely within the Microsoft Customer Relationship Management (CRM) system.
• Manage escalated and time sensitive case management questions received from members, broker relationships, and internal and external Allied stakeholders.
• Collaborate with strategic vendor partners to provide supportive services and support to members.
• Lead and facilitate claims auditing in conjunction with ECM Coordinators.

ECM Coordinator III supporting medical management at Allied Benefit Systems.

Case Management Coordinator III

ECM Coordinator III supporting department staff with administrative tasks about members' medical conditions. Engaging with members to offer support and resources through Allied Care.

• Establish and maintain contact with hospital/facility case managers, social workers, nurses, discharge planners, and other clinical points of contact.
• Obtain clinical updates, treatment plan information, anticipated length of stay, discharge planning status, and barriers to discharge.
• Review available medical records and summarize relevant clinical information.
• Document clinical updates, communication attempts, discharge information, pending items, and next steps in designated systems.
• Communicate with prison medical teams when treatment plans, discharge needs, or care coordination questions require clarification.
• Support communication related to transfers, direct admissions, facility acceptance, and physician-to-physician coordination when appropriate.
• Collaborate with Correctional Account Coordinators, Account Managers, medical records teams, and other internal stakeholders to ensure accurate and timely case updates.
• Maintain current case information in AXIS, Salesforce, SharePoint, spreadsheets, and other designated platforms.
• Complete final documentation and case updates following discharge or transfer.
• Prepare and send weekly case management reports to designated prison contacts.
• Escalate clinical deterioration, unclear treatment plans, discharge barriers, communication gaps, or urgent concerns to management and appropriate stakeholders.

LCSW Case Coordinator managing case activities for incarcerated individuals

BOP Case Coordinator

LCSW Case Coordinator providing clinical case management for incarcerated individuals at Seven Corners. Liaising with prison medical teams and external healthcare facilities for effective care coordination.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals
• Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions
• Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
• Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans
• May identify, initiate, and participate in on-site reviews
• Serves as member advocate through continued communication and education
• Promotes enrollment in care management programs and/or health and disease management programs
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members
• Performs medical or behavioral review/authorization process
• Ensures coverage for appropriate services within benefit and medical necessity guidelines
• Utilizes allocated resources to back up review determinations
• Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)
• Participates in data collection/input into system for clinical information flow and proper claims adjudication
• Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal)
• Maintains current knowledge of contracts and network status of all service providers and applies appropriately
• Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services

Case Management Coordinator managing care interventions at BlueCross BlueShield.

Case Management Coordinator, Social Worker

Case Management Coordinator controlling care coordination interventions and working on improving service delivery at BlueCross BlueShield.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals
• Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions
• Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
• Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans
• May identify, initiate, and participate in on-site reviews
• Serves as member advocate through continued communication and education
• Promotes enrollment in care management programs and/or health and disease management programs
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members
• Performs medical or behavioral review/authorization process
• Ensures coverage for appropriate services within benefit and medical necessity guidelines
• Utilizes allocated resources to back up review determinations
• Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)
• Participates in data collection/input into system for clinical information flow and proper claims adjudication
• Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal)
• Maintains current knowledge of contracts and network status of all service providers and applies appropriately
• Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services

Case Management Coordinator focusing on maternity care management at BlueCross BlueShield

Case Management Coordinator, Maternity Focus

Case Management Coordinator focusing on maternity care management at BlueCross BlueShield of South Carolina. Responsible for care coordination and serving as an advocate for clients with chronic conditions.

• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists
• Assists in resolution of customer complaints and quality assurance issues as needed

Case Coordinator ensuring high quality medical review reports

Case Coordinator responsible for quality assurance of medical review reports. Working with the Quality Assurance Department to maintain compliance and quality standards.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals.
• Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions.
• Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits.
• Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans.
• May identify, initiate, and participate in on-site reviews.
• Serves as member advocate through continued communication and education.
• Promotes enrollment in care management programs and/or health and disease management programs.
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
• Performs medical or behavioral review/authorization process.
• Ensures coverage for appropriate services within benefit and medical necessity guidelines.
• Utilizes allocated resources to back up review determinations.
• Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
• Participates in data collection/input into system for clinical information flow and proper claims adjudication.
• Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
• Maintains current knowledge of contracts and network status of all service providers and applies appropriately.
• Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.

Case Management Coordinator coordinating care for BlueCross BlueShield of South Carolina.

Case Management Coordinator focusing on care management and patient education for BlueCross BlueShield of South Carolina. Ensuring client safety and advocating for member needs through effective communication and coordination.

RN Case Management Coordinator for BlueCross BlueShield of South Carolina

RN Case Management Coordinator – NICU, Maternity

RN Case Management Coordinator focusing on care coordination for BlueCross BlueShield of South Carolina. Enhancing client safety and well-being through effective care management interventions.

Case Coordinator jobs in United States

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Intensive Case Management Coordinator - Field

Case Management Coordinator

Case Management Coordinator

Case Management Coordinator – Field

Case Management Coordinator – Field, Illinois

RN Case Management Coordinator, Maternity/NICU

Field Case Management Coordinator

Case Management Coordinator – Field, Illinois

Case Management Coordinator, Assessor Team

Case Coordinator

Case Coordinator

Perinatal Case Coordinator

Case Management Coordinator III

BOP Case Coordinator

Case Management Coordinator, Social Worker

Case Management Coordinator, Maternity Focus

Case Coordinator

Case Management Coordinator, Maternity Focus

RN Case Management Coordinator – NICU, Maternity