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