Insurance Case Manager Jobs in Gainesville, FL (NOW HIRING)

Shape Your Future. Serve Your Community. Build Your Career with Palms!

What Life Working at Palms Looks Like:

Mission and Meaningful Work: PMG is a not for profit, Federally Qualified Health Center (FQHC). That means it’s focused on serving underserved populations, offering affordable primary care and preventative services. For many people, that makes the work feel meaningful.

Stability & Growth: PMG has been around for a long time (since 1971) and we are still expanding!

Comprehensive Services & Variety: We offer a wide array of services – family medicine, pediatrics, dental, behavioral health, prenatal care, etc. – So working here gives exposure to different patient populations, conditions and settings.

Patient-Centered, Community Focus: PMG emphasizes accessible care (same day scheduling, weekend appointments, bilingual staff) and works in communities throughout North Florida. It is also a Patient Centered Medical Home (PCMH), meaning there’s an emphasis on continuity of care, relationships with patients, etc.

Culture & Community: Many reviews say that PMG has a “friendly, compassionate, professional” environment. There is pride among the staff in giving back to the community.

Perks:

Competitive Wages

Comprehensive Health Coverage: Medical, Dental and Vision Insurance

Professional Development Opportunities

Employee Assistance Programs

Company Paid Life Insurance

401k with 5% Match

11 Paid Holidays

20 Days PTO

Recognition and Rewards

Community Impact .

Position Summary

The Case Manager is responsible for delivering exceptional customer service and ensuring the accurate, timely, and thorough coordination of patient referrals. This role supports continuity of care by managing referral workflows, securing authorizations, and serving as a liaison between patients, providers, and external specialists. The Case Manager also identifies community resources and supports patients in overcoming barriers to care.

Description of Primary Responsibilities

1) Customer Service

a) Provide professional and courteous support to patients in accordance with Palms Medical Group within his/her field of training in accordance with stated policies and procedures of PMG.

c) Answer, screen and route telephone calls promptly and professionally (within 3 rings)

e) Operate a multi-line phone system efficiently, including transferring calls, managing voicemail and navigating queues).

f) Document phone interactions in the EHR.

g) Maintain a working knowledge of all PMG departments and services.

2) Referral Coordination

a) Follow standardized referral policies and workflows

b) Prioritizes referrals based on urgency and organizational goals.

c) Ensures complete and accurate demographic, insurance information and clinical information is submitted to specialists

d) Communicate referral details and expectations to both providers and patients. including next steps and contact

e) Ensure all necessary consents are obtained or coordinated

f) Process incoming and outgoing patient data to support continuity of patient care

3) Community Resource Utilization

a) Identify and maintain relationships with local service providers and community resources.

b) Assist patients in navigating to language or social barriers that may impact referral completion.

4) Referral Tracking

a) Follow EHR protocols for referral tracking.

b) Retrieve and document from the inbox.

c) Record all reports received and close open orders per PMG policy and procedure

d) Ensure timely processing of all referrals.

5) Insurance Authorizations

a) Contact insurance companies to verify and obtain prior authorizations.

b) Present necessary medical information to prove medical necessity of services

c) Maintain knowledge of insurance-specific authorization requirements and document accordingly.

6) Administrative Duties

a) Adhere to the Referrals Policy Manual, Medical Records Policy Manual and HIPAA Policy Manual

b) Check and respond to emails at least twice daily.

c) Maintain patient confidentiality in compliance with HIPAA regulations.

d) Assist with audits and surveys as directed by the Case Manager Coordinator

e) Perform any other duty assigned by the Case Manager Coordinator, Executive VP of Patient Services or CEO to improve the efficiency of PMG

Description of Primary Attributes

General Development:

1) Must be organized, a self-starter and detailed oriented

2) Job duties require the ability to work independently and as part of a team

3) Expected to multitask

4) Know referral sources in one’s geographical area

5) Assist in the training and mentoring of coworkers by sharing knowledge, providing guidance, and supporting skill development.

Professional & Technical Knowledge:

1) Employee will have a Working Knowledge of the following office equipment:

• Multiline Telephone
• Copier
• Computer
• Email
• Scanner
• Fax Machine

2) Employee will be expected to navigate and operate Microsoft Office suite products, including Word, Excel and Teams

Education & Experience:

1) High School Diploma or Equivalent

2) 1-year prior experience in insurance verification and referrals

Communications Skills:

Effectively communicates complex and/or technical information to co-workers, patients and/or vendors

Physical/Mental/Emotional Demands:

• Standing for long periods of time
• Sitting for long periods of time
• Viewing a computer monitor for long periods of time
• Bending
• Stretching / Reaching
• Walking short distances
• Lifting up to 50 pounds
• Operating office equipment (computer, fax machines, telephones and copy machines)
• Reading forms / Instructions / Patients Charts
• Communicating well to people of various ages, educational levels, cultural backgrounds in person or by telephone
• Exposure to potentially violent / irate patients
• Health / Safety Consideration of Position
• Exposure to chemical infectious / contagious illness
• Exposure to chemical and inhalation of antibiotics during reconstitution
• Exposure to X-Ray radiation
• Exposure to a variety of scents and odors
• Must utilize universal precaution in clinical or exposure situations as prescribed by federal state, and local guidelines and /or laws