Telephonic Medical Case Manager (Workers' compensation)

POSITION SUMMARY: The medical case manager provides telephonic case management in a workers' compensation environment, coordinating resources and cost-effective options on a case-by-case basis to facilitate quality individualized treatment goals and return to work placement.ESSENTIAL DUTIES AND RESPONSIBILITIES: Possess excellent communication and organizational skills to interface with the client, claimants, and staff. Work well independently and set priorities.Primary responsibilities include:Provide telephonic outreach for assessment and follow-up for case communication and coordination to include assessing, planning, implementing, coordinating careConducts and documents initial assessment with the injured worker, employer, and provider and maintains regular contact with all parties involved to facilitate communication and formulate a clinical case planResponsible for coordination of contact with provider, claimant, RTW contact, and claims examinerReviews case records and reports, collects and analyzes data, evaluates client's medical status, and defines needs and problems in order to provide proactive case management servicesAssessment of medical records for appropriateness of treatment and level of care being provided. Referral to the Medical Director if appropriate within the established timeframesFacilitate timely return to work date coordinating RTW with the claimant, employer, and physiciansMaintains contact and communicates updated activity with all parties involved with the caseTelephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and, identify potential issues and promote positive treatment outcomes. Negotiate treatment plan with treating physicianAdditional Functions and ResponsibilitiesDemonstrates ability to meet administrative requirements, including productivity, time management, and Quality Assurance standardsMaintain minimum billing and established template documentation standards adhering to URAC standards and company policy and proceduresReporting billing hours in accordance with case activity and billing practicesMaintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHIOther job duties as assignedEQUIPMENT OPERATED/USED:Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System ApplicationsEssential Tools: Pens, pencil, computer, KeyboardEssential Vehicles: N/ASPECIAL EQUIPMENT OR CLOTHING:Professional attire adhering to the Company Dress CodeExperience:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.Three or more years of diverse clinical experience in caring for acutely ill patients with multiple disease conditionsThree or more years of Managed Care and or Worker's Compensation experienceKnowledge of utilization management, quality improvement, discharge planning, and cost managementBackground in state worker's compensation law and practices desirableAbility to solve practical problems and deal with a variety of variablesPossess planning, organizing, conflict resolution and negotiating skillsExcellent interpersonal skills and excellent organizational skills.Proficient with Microsoft Office applications including Word, Excel, and Power PointEducation:Diploma, associate or bachelor’s degree in nursing, Master's level (or higher) in a Nursing, Health or Human Services field or equivalent related experience preferredCurrent, unrestricted RN license requiredCCM, CPDM, COHN or CDMS certification preferred #J-18808-Ljbffr