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.

Key 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.

Requirements & Tech Stack

• 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.
• Bilingual (English/Spanish) is preferred.