Field Case Manager - Temecula, CA

Charles Taylor is a highly successful global provider of professional services to the insurance industry. Guardian Managed Care Solutions, a division of Charles Taylor TPA, is a leading provider of workers’ compensation managed care and cost containment solutions. We are seeking a dynamic Field Case Manager to join our team. This role is based in Temecula, CA region but we provide flexibility to work remotely. Job Summary The Field Case Manager position is responsible for assessing and analyzing information pertinent to injured employees to evaluate the medical and vocational needs required to facilitate the patient’s rehabilitation in order to promote appropriate and timely return to work. This person will act as a liaison between patient/family, employer, provider(s), healthcare personnel, adjusters, and attorneys involved in workers’ compensation claims. Essential Functions Obtains medical history of the injured employee and a signed medical release form when appropriate for medical care coordination purposes Requests, obtains, and reviews medical records Assess 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 team of case managers and support staff Requirements Must hold at least one of the following credentials: CCM, CRRN, CDMS, COHN, CRC 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 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 Ability to work independently, within a team environment, and deal effectively with multiple tasks simultaneously Must possess strong professional communication, organizational, and interpersonal skills when interacting verbally and in writing Strong customer service skills Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details Computer literacy, daily usage of MS Office Product Suite, i.e., Word, Excel, PowerPoint, Teams Ability to proofread typed material for grammatical, typographical, or spelling errors Ability to change and adapt work activities frequently while prioritizing projects Knowledge of operating standard office equipment i.e., computer, fax, copier, scanner, phone, etc Additional Experience (preferred but not required) 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 terminolog Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, life insurance and 401(K) with match. #J-18808-Ljbffr Case Management Society of America (CMSA) ®