• Medical Case Manager, Field

    Job Location(s) US-CA-San Diego | US-Remote
    Job ID
    2018-1629
    # of Openings
    1
    Category
    Case Management
    Job Type
    Regular Full-Time
  • Overview

    Position Summary:

    The medical case manager provides field 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.

    Responsibilities

    Essential Duties and Responsibilities:

     

    Possess excellent communication and organizational skills to interface with the client, claimants, physicians and staff. The ability to work well independently and set priorities is essential.

    Primary responsibilities include:

    • Manages one-time task assignment or full field case management referral to meet with attending physician, injured worker and/or employer to clarify medical and/or vocational claim related information which could not be obtained through correspondence or telephonic attempts by claims team.
    • Assesses and analyzes injured worker's medical and vocational status.
    • Attend medical appointments with an injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes. Negotiate treatment plan with treating physician
    • Develops plan of care to facilitate medical recovery and progressive return to work.
    • Collaborates with members of the health care team to provide ongoing case management services.
    • Acts as liaison for involved parties in the worker's compensation injury by communicating in person and telephonically with the patient/caregiver, attorneys, employer, claims examiners, telephonic nurse case manager, return to work specialists, vocational rehabilitation supervisor, provider(s), ancillary provider(s) and health care team.
    • Monitors injured employee's progress towards established outcomes through continued assessment and evaluation.
    • Coordinates necessary referrals, consultations, and therapeutic services for the injured employee. Researching alternative treatment programs
    • Works with employers on modifications of job duties based on medical limitations and the employees functional assessment
    • Completes the interview process with the patient/caregiver in the home, worksite, ancillary location or physician's office for current and ongoing assessments and evaluations.

    Additional Functions and Responsibilities

    • Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
    • Maintain minimum billing and established template documentation standards adhering to URAC standards and company policies and procedures
    • Reporting billing hours in accordance with case activity and billing practices
    • Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
    • Travels as required
    • Other job duties as assigned

     

     

    Equipment Operated/Used:

    • Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse
    • Essential Tools: Pens, pencil, computer, Keyboard
    • Essential Vehicles: Valid driver’s license and maintain current vehicle insurance

    Qualifications

    Education:

    • 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 preferred.
    • Current, unrestricted RN license required
    • CCM, CPDM, COHN or CDMS certification preferred

     

    Experience:

    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 the acutely ill patients with multiple disease conditions. 
    • Three or more years of Managed Care and/or Worker’s Compensation experience
    • Knowledge of utilization management, quality improvement, discharge planning, and cost management
    • Background in state worker’s compensation law and practices desirable
    • Ability to solve practical problems and deal with a variety of variables
    • Possess planning, organizing, conflict resolution, negotiating skills. 
    • Excellent interpersonal skills and excellent organizational skills
    • Proficient with Microsoft Office applications including Word, Excel, and Power Point

     

     

     

     

     

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