Medicaid and Insurance Case Specialist
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Job Location:
Manahawkin, NJ - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
About the Role
We are seeking a Medicaid and Insurance Case Specialist with strong experience working for or alongside major Managed Care Organizations (MCOs) in New Jersey. The ideal candidate will have a deep understanding of NJ Medicaid programs waiver services and insurance case management processes. This position will focus on supporting members and families in navigating eligibility authorizations and service coordination while ensuring compliance with state and MCO policies.
Key Responsibilities
Case Management and Support
Manage a caseload of members requiring assistance with Medicaid insurance benefits and waiver services.
Guide clients through eligibility enrollment and authorization processes for NJ Medicaid programs.
Serve as the primary point of contact for members families and providers ensuring timely resolution of service and coverage issues.
Coordination and Liaison
Collaborate with discharge planners social workers physicians and other healthcare professionals to coordinate care plans.
Act as a liaison between clients caregivers providers and MCO case managers to address insurance or service challenges.
Facilitate communication between home care agencies and MCOs to streamline service authorizations and claims processing.
Compliance and Documentation
Maintain accurate case records in compliance with Medicaid and MCO standards.
Monitor program requirements and ensure services are delivered in line with state and federal regulations.
Stay current with NJ Medicaid policy updates including Managed Long-Term Services and Supports (MLTSS) and other waiver programs.
Member Advocacy and Education
Educate members and families on available benefits waiver programs and care options.
Advocate on behalf of clients to resolve service access or coverage disputes.
Support families during transitions of care to ensure continuity and quality of services.
Qualifications
Experience
Minimum of 35 years of experience in insurance case management Medicaid programs or MCO operations.
Direct experience with New Jersey Medicaid MLTSS and waiver programs strongly preferred.
Prior work with one of the states leading MCOs (Amerigroup Horizon NJ Health UnitedHealthcare Community Plan WellCare or Aetna Better Health) is highly desirable.
Skills & Competencies
Strong knowledge of NJ Medicaid regulations waiver programs and insurance case management practices.
Ability to manage complex caseloads with attention to detail and regulatory compliance.
Excellent communication and interpersonal skills for working with diverse populations.
Strong problem-solving negotiation and advocacy skills.
Proficiency in case management systems and Microsoft Office Suite.
Education
Bachelors degree in Social Work Nursing Healthcare Administration or related field preferred.
Equivalent experience may be considered.
Benefits
Competitive salary with annual performance incentives.
Comprehensive health dental and vision insurance.
Paid time off and retirement plan options.
Opportunities for professional growth within the organization.
Required Experience:
Unclear Seniority
Key Skills
- Sales Experience
- Time Management
- Marketing
- Customer Service
- Communication skills
- Retail Sales
- Business Management
- Outside Sales
- Telemarketing
- Insurance Sales
- Medicare
- Phone Etiquette
About Company
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