Case Coordinator (32408)

AllMed is looking for a detail-oriented Case Coordinator to join our team!

SUMMARY

The Case Coordinator is responsible for conducting high-volume outbound calls to healthcare providers and patients in support of case management operations. This role focuses on gathering timely information to facilitate turnaround times and support overall client service delivery. The ideal candidate is detail-oriented, professional on the phone, and comfortable navigating conversations with both clinical offices and patients. While the primary focus is outbound communication, this role offers the opportunity to expand into broader case support functions over time.

The hours for this position are Monday through Friday 10:00 AM to 6:30 PM EST

RESPONSIBILITIES:

• Conduct outbound calls to physician offices, healthcare providers, and patient to obtain required clinical and administrative information.
• Clearly communicate the purpose of the call and gather accurate, complete documentation needed for case processing
• Follow established call scripts and workflows
• Document all call interactions thoroughly and accurately within internal systems
• 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.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are adhered to the final report.
• Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Ensures all federal ERISA and/or state mandates are always adhered to.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promotes effective and efficient utilization of company resources.
• Participates in various educational and or training activities as required.

• Performs other duties as assigned.