Surgical Case Manager

About the Company

CitiMed is seeking a detail-oriented and organized Entry-Level Surgical Case Manager to support the coordination and oversight of surgical patients across Workers' Compensation (WC), No-Fault (NF), and Medical Lien cases. This role is ideal for a motivated individual looking to build a career in medical case management within a fast-paced, multi-specialty clinical environment. The Surgical Case Manager will work closely with treating physicians, physician assistants, billing staff, attorneys, and insurance carriers to ensure timely authorization, documentation, and continuity of care for surgical patients from pre-authorization through post-operative discharge.

About the Role

This role is ideal for a motivated individual looking to build a career in medical case management within a fast-paced, multi-specialty clinical environment.

Responsibilities

• Manage and track a caseload of surgical patients across Workers' Compensation, No-Fault, and Medical Lien claims from initial evaluation through post-operative care.
• Submit and follow up on Prior Authorization Requests (PARs) for surgical procedures, DME, and post-operative physical therapy through the NY Onboard portal and carrier-specific platforms.
• Review and interpret denial letters and utilization review determinations; coordinate with physicians and legal staff to prepare appeal documentation and supporting clinical records.
• Ensure clinical documentation is complete, accurate, and submitted within required timeframes to support authorization and billing.
• Communicate with Workers' Compensation carriers, No-Fault insurers, and lien holders regarding claim status, authorizations, and treatment updates.
• Coordinate scheduling of pre-operative appointments, surgical procedures, and post-operative follow-up visits.
• Liaise with attorneys, adjusters, and third-party administrators on case status, legal holds, and lien resolution as needed.
• Monitor patient compliance with prescribed physical therapy, home exercise programs, and follow-up appointments; document and communicate non-compliance as appropriate.
• Maintain organized and up-to-date case files in the practice management system, ensuring all authorizations, denial letters, appeal submissions, and correspondence are properly documented.
• Assist in preparing Statements of Medical Necessity and other supporting documents as directed by the treating provider.

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree in Health Sciences, Healthcare Administration, or related field preferred.
• 0-2 years of experience in a medical office, case management, or healthcare administrative role; experience with WC or NF cases a plus.
• Familiarity with medical terminology, surgical CPT codes, and ICD-10 diagnosis codes preferred.
• Knowledge of the NY Onboard prior authorization portal and NYS Workers' Compensation Board processes is a plus.
• Strong organizational skills with the ability to manage multiple cases simultaneously and meet deadlines.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office (Word, Excel, Outlook); experience with practice management or EMR software preferred.
• Ability to work collaboratively with clinical, administrative, and legal teams.

Required Skills

• Strong organizational skills
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office
• Ability to work collaboratively

Preferred Skills

• Familiarity with medical terminology
• Knowledge of NY Onboard prior authorization portal
• Bilingual (English/Spanish)

Equal Opportunity Statement

CitiMed is an equal opportunity employer. We are committed to building a diverse and inclusive workplace.