Field Case Manager

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.


Job Summary


Our client is seeking a dedicated Field Case Manager responsible for assessing and analyzing information related to injured employees to evaluate their medical and vocational needs. The role aims to facilitate the patient's rehabilitation, promoting an appropriate and timely return to work while acting as a liaison between patient/family, employer, provider(s), healthcare personnel, adjusters, and attorneys involved in workers' compensation claims. There is one job opening in Los Angeles County and one in San Diego County.


Responsibilities / Job Duties

• Obtains medical history of the injured employee and a signed medical release form for medical care coordination purposes.
• Requests, obtains, and reviews medical records.
• Assesses and analyzes an injured employee's medical and vocational status.
• Develops a plan of care to facilitate the patient's appropriate and timely return to work; coordinates with the employer when appropriate.
• Interviews patients in the physician office, home and/or work site to provide ongoing case management services.
• Communicates both in-person and telephonically with patients, medical providers, adjusters, attorneys, and vendors.
• Schedules appointments for implementation and follow-up of treatment plan.
• Coordinates and monitors progress and completion of vendor referrals, consultations, and therapeutic services for patients.
• Ensures transportation and translation are available for the injured employee to attend medical appointments when appropriate.
• Accompanies the injured employees during physician consultations when appropriate.
• Conferences with specialists concerning course of care and treatment.
• Ensures all injured employees' and employers' concerns are addressed by the physicians.
• Ensures injured employees understand diagnosis of their injury/illness, and any instructions and recommendations regarding treatment when appropriate.
• Provides consistent monitoring, contact, support, and education to injured employees to monitor patients' progress toward desired outcomes, promote compliance, motivation, and address issues as they arise when appropriate.
• With adjuster approval, coordinate necessary medical and rehabilitative care for injured employees including but not limited to appointments, medications, surgery, therapies, diagnostics, equipment, transportation, translation etc.
• Establishes effective rapport with all professions involved in the injured employees' rehabilitation process to facilitate treatment, optimum care, and successful return to work.
• Provides comprehensive documentation detailing case management services, the injured employees' progress with treatment plan, return to work status, maximum medical improvement, and significant events that meets company standards for content and format.
• When appropriate, coordinate return to work issues with the employer, to include job site analysis, ergonomic evaluation, etc., and present to the physician for review.
• Maintains a working knowledge of up-to-date medical information including but not limited to medications, procedures, equipment, therapies, treatments, their uses, contraindications, side effects, etc., and provides research information to adjusters to assist with determinations of medical necessity and appropriateness.
• Applies all laws and regulations relative to the provision of case management and rehabilitation services in the geographic region assigned.
• Testifies as required to substantiate any relevant case work or documentation.
• Timely completion of time and expense reporting per company guidelines.
• Works closely with a team of case managers and support staff.

Minimum Education and Experience Qualification Requirements


Certifications

• Must hold at least one of the following credentials: CCM, CRRN, CDMS, COHN, CRC, or willingness to obtain within 12 months of hire.

State License

• Must hold an unrestricted Registered Nurse license in the state of California.
• Must maintain all applicable credentials, licensure, and/or certification(s) for case management in the state of California.

Qualifications

• 3-5 years of clinical experience (orthopedics, post-op, pre-op, ICU, cardiac)
• 1+ years of case management experience
• Must have current, unrestricted driver's license and be able to provide proof of automobile insurance
• Ability to travel day to day within assigned geographic region
• Must have insurance or utilization background
• Knowledge of diagnostics and appropriate treatment plans
• Computer literacy, daily usage of MS Office Product Suite, i.e., Word, Excel, PowerPoint, Teams. Knowledge of operating standard office equipment i.e., computer, fax, copier, scanner, phone, etc.

Preferred Skills

• Workers comp background would be preferred, or short-term or long-term disability
• Case management experience at a Third-Party Administrator (TPA), in the medical field, or workers compensation industry
• Knowledge or experience with the statutes and rules of Longshore and Harbor Workers' Compensation Act and Jones Act Claims
• Knowledge or experience with the statutes and rules of the State of California Workers' Compensation claims
• Spanish speaking, both conversational and medical terminology

Schedule / Shift


M-F 8-5


Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


Medix Overview:


With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.


* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.