Medicaid Case Manager

Job Summary

We are seeking a compassionate, organized, and results-oriented Medicaid Case Manager to assist Medicaid recipients in accessing healthcare, social services, and community resources. The Medicaid Case Manager will assess client needs, review individualized service plans, coordinate care, monitor progress, and advocate for individuals and families to achieve optimal health and wellness outcomes.

The ideal candidate will possess strong communication skills, knowledge of Medicaid programs, and a commitment to serving vulnerable populations.

Essential Duties

• Review comprehensive assessments to identify client needs, strengths, and barriers to care.
• Ensure compliance with all federal, state, and Medicaid program requirements
• Review and support person-centered care plans in collaboration with clients, families, and healthcare providers.
• Coordinate medical, behavioral health, social, and community support services.
• Maintain regular contact with clients to monitor progress and ensure service plan goals are being met.
• Assist clients in navigating Medicaid benefits, eligibility requirements, and available resources.
• Advocate on behalf of clients to ensure access to appropriate services and supports.
• Facilitate referrals to healthcare providers, specialists, housing programs, transportation services, employment resources, and community agencies.
• Maintain accurate, timely, and compliant documentation in accordance with Medicaid regulations and organizational policies.
• Participate in interdisciplinary team meetings and case reviews.
• Monitor service utilization and identify opportunities to improve client outcomes.
• Perform utilization review and management to ensure appropriate use of hospital and outpatient services while adhering to compliance standards such as HIPAA.
• Provide patient education on health insurance benefits, medication management, and available community resources.
• Maintain accurate documentation within EMR (Electronic Medical Record) and EHR (Electronic Health Record) systems, ensuring compliance with privacy regulations.
• Communicate effectively with clients from diverse cultural backgrounds, fostering trust and understanding throughout the case management process.

Required Skills

• Critical care experience combined with hospital experience in settings such as ICU, emergency medicine, or trauma centers.
• Strong knowledge of medical terminology, CPT coding, ICD-9/10 coding systems for billing and documentation purposes.
• Experience working with managed care organizations and understanding health insurance policies related to Medicaid.
• Proficiency in EMR/EHR systems along with Microsoft Office tools for documentation and reporting.
• Excellent client communication skills with the ability to work effectively with individuals from diverse backgrounds.
• Knowledge of community-based services and organizations (state and local).

Core Competencies

• Critical Thinking
• Analytic Skills
• Problem Solving
• Interpersonal (Written and Verbal) Communication
• Time Management
• Ability to effectively complete job duties with minimum supervision
• Documentation Accuracy (proficient writing skills)
• Detailed Oriented
• Client Advocacy
• Care Coordination
• Cultural Competency
• Confidentiality and Professional Ethics
• Team Collaboration

Required Qualifications

• Bachelor's degree in Social Work, Human Services, Psychology, Sociology, Nursing, or a related field.
• Minimum of one (1) year of case management, healthcare, behavioral health, social services, or related experience.
• Knowledge of Medicaid programs and community-based services.
• Strong assessment, documentation, and organizational skills.
• Excellent verbal and written communication abilities.
• Proficiency in Microsoft Office Suite and electronic health record systems.
• Reliable transportation and the ability to travel locally for client visits as required.

Preferred

• Louisiana Medicaid Case Management experience.
• Bilingual abilities are a plus to serve a broader patient population effectively.

Join us in delivering compassionate case management that transforms lives! We are committed to fostering an inclusive environment where every team member can thrive professionally while making a positive impact on the communities we serve.

Pay: $25.35 - $30.52 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Professional development assistance
• Vision insurance

Work Location: Hybrid remote in Baton Rouge, LA 70816

Salary : $25 - $31