• Medical Case Manager, Field

    Job Location(s) US-CO-DENVER/ Lakewood | US-Remote
    Job ID
    # of Openings
    Case Management
    Job Type
    Regular Full-Time
  • Overview

    Position will be remote, working from home, however prefer someone in Denver area.



    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.


    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





    • 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


    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

    Equipment Operated/Used:

    • Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse
    • Essential Tools: Pens, pencil, computer, Keyboard
    • Essential Vehicles: Car (for field assignment); Valid driver’s license and maintain current vehicle insurance


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