Case Management Specialist ( Healthcare

Tenderness Health Care | Milwaukee

Full-Time

• Milwaukee — 823 S Layton Blvd, Milwaukee, WI 53215
• Shorewood — 3569 N Oakland Ave, Suite B, Shorewood, WI 53211

For more than 15 years, Tenderness Health Care has been committed to providing quality care while building a workplace where employees feel valued, respected, and supported.

As we continue to experience rapid growth and expand our healthcare services, we are creating new opportunities for talented professionals who want to grow with us.

We are looking for an A+ team player who takes pride in their work, values teamwork and accountability, and is excited to build a long-term career with an established and growing healthcare organization.

At Tenderness, your work matters, your contributions are appreciated, and there is opportunity to grow as we grow.

The Bilingual Case Management Specialist is responsible for coordinating medical documentation, client records, service authorizations, Plans of Care, recertifications, and communication among clients, physicians, nurses, insurance entities, and internal departments.

This position helps ensure required documentation is complete, accurate, properly maintained, and processed within required time frames to reduce delays or interruptions in services.

The ideal candidate is highly organized, detail-oriented, comfortable working in a healthcare environment, and able to manage multiple time-sensitive responsibilities while maintaining professionalism and confidentiality.

• Communicate professionally with clients, physicians, medical offices, nurses, and internal departments regarding documentation and processing updates
• Coordinate with nursing staff regarding assessments, medical documentation, and administrative service requirements
• Request medical records from physician offices, clinics, schools, and other appropriate entities
• Maintain consistent follow-up until required documentation is received
• Review received records for completeness and required administrative information
• Identify documentation relevant to authorization and service-processing requirements
• Escalate clinical questions or determinations to the appropriate licensed clinical staff
• Verify physician information, insurance information, and other required client information through approved systems
• Scan, upload, organize, and maintain medical documentation within the electronic health record
• Ensure documentation is associated with the correct client record

• Complete accurate data entry into applicable healthcare systems
• Maintain current client demographic, insurance, physician, and service information
• Upload medical records, assessments, authorizations, Plans of Care, and supporting documentation
• Review electronic records for missing, outdated, or incomplete documentation
• Follow up with appropriate team members regarding outstanding items
• Maintain organized records to support authorizations, recertifications, audits, and ongoing service delivery
• Help ensure documentation is processed according to internal timelines and applicable program requirements

• Request RN assessments when required
• Coordinate with nursing staff regarding pending assessments and documentation
• Track completion of nursing assessments
• Enter information from completed nursing assessments into approved systems or forms as directed, without changing clinical findings
• Follow up regarding incomplete or outstanding documentation
• Assist with coordinating documentation for new clients, amendments, recertifications, and service changes
• Escalate clinical documentation questions to the appropriate licensed nurse or clinical supervisor

• Prepare and process Plans of Care and related documentation based on approved clinical and authorization information
• Ensure Plans of Care accurately reflect information provided by appropriate clinical and authorization sources
• Route Plans of Care for required clinical review and signatures
• Track outstanding physician signatures and follow up as needed
• Upload completed Plans of Care into the appropriate electronic record
• Monitor Plan of Care effective dates and renewal requirements
• Maintain accurate documentation related to Plan of Care processing

• Assist with preparing and submitting authorization-related documentation
• Track pending authorizations and follow up on outstanding requests
• Monitor…