Top 1 Medical case manager Jobs in Fajardo, Pr

Medical Case Manager
Family Medicine Group —Carolina, PR
- $11 - $14 an hour
- Full-time
- Bilingual
- HIPAA
- Mid-level
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5d

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*Bachelor’s degree* in Social Work, Psychology, Human Services, or related field. Conduct assessments and develop service plans.
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Medical Case Manager

Family Medicine Group
Carolina, PR

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Job Details

Full-time
$11 - $14 an hour
5 days ago

Qualifications

Bilingual
Behavioral health hospital experience
Patient and family consultation
Patient resource coordination
Utilization review
Psychosocial assessment
PICU experience
Interdisciplinary collaboration in health services social work
Pediatric unit experience
Health insurance policy knowledge
Working with pediatric populations
HIPAA
Patient advocacy
Critical & intensive care
Care documentation
Mid-level
Medical social work
Managing patients as a nurse case manager
Transitional care planning in clinical case management
Acute care facility experience
Overseeing care coordination
Medical coding for emergency department records
Electronic health record (EHR) management for billing and coding
Utilization management
Decision making
Resource utilization in healthcare
Health information regulatory compliance
Health record tracking
Patient family and caregiver education
Pediatrics

Full Job Description

Header

Job Overview
Join our dynamic healthcare team as a Medical Case Manager, where you will play a vital role in coordinating patient care across diverse medical settings. This energetic position offers the opportunity to utilize your clinical expertise, communication skills, and passion for patient advocacy to improve health outcomes. As a key connector between patients, healthcare providers, and insurance entities, you will ensure seamless care transitions, optimize resource utilization, and support patients through complex medical journeys. Your dedication will help foster a compassionate, efficient, and patient-centered environment that promotes healing and well-being.

Responsibilities

Conduct comprehensive assessments of patients’ medical, social, and psychological needs to develop personalized care plans.
Coordinate hospital discharges and facilitate smooth transitions to post-acute services or home care.
Collaborate with multidisciplinary teams including social workers, physicians, nurses, and therapists to ensure coordinated treatment.
Perform utilization review and management to verify appropriateness of services and optimize healthcare resources.
Maintain accurate documentation within Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems while adhering to HIPAA regulations.
Communicate effectively with patients and their families to provide education, support, and advocacy throughout their care journey.
Utilize clinical knowledge—including critical care experience, hospital experience, and specialized fields like ICU or PICU—to inform case decisions.
Apply coding expertise such as CPT (Current Procedural Terminology), ICD-9/10 (International Classification of Diseases), and ICD coding standards for accurate documentation.
Engage in discharge planning activities for patients across various settings including trauma centers, emergency departments, hospice care, or behavioral health units.
Participate in utilization management activities to ensure compliance with insurance requirements and healthcare policies.

Skills

Critical care experience combined with hospital and acute care background enhances clinical decision-making.
Proficiency in nursing practices along with strong knowledge of medical terminology and health insurance processes.
Experience working within EMR/EHR systems; familiarity with Microsoft Office suite for reporting and documentation.
Knowledge of HIPAA regulations ensuring confidentiality and secure handling of patient information.
Skilled in CPT coding, ICD-9/10 coding standards for precise documentation and billing processes.
Strong discharge planning abilities coupled with expertise in social services and working with diverse cultural backgrounds.
Excellent client communication skills; bilingual capabilities are a plus for serving varied populations.
Background in managed care, utilization review/management, and familiarity with Level I & II trauma center protocols.
Experience in pediatrics or behavioral health settings is advantageous for specialized case management roles.
Join us if you’re passionate about making a difference through proactive case management—where your expertise fuels better health outcomes every day!

Pay: $11.00 - $14.00 per hour

Work Location: In person

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medical case manager jobs in fajardo, pr

Medical Case Manager

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