Full-Time Clinical Case Manager
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To be fully engaged in providing Customer Experience, and Stewardship. Responsible for ensuring the injured associates receive appropriate treatment directly related to the compensable injury and assists the TPA in managing medical treatment to an appropriate to resolution. The Workers’ Compensation Clinical Case Manager coordinates resources and creates flexible, appropriate return to work plans, coordinates referrals, and watches EOBS for denials and other issue with each Worker’s Comp or Motor Vehicle Accident/No Fault claim. On case-by-case basis facilitates quality treatment goals, including timely return to work if appropriate.
- Coordinates the injured worker’s medical and physical conditions with the treating physicians, along with discussing/recommending alternate treatment plans for the patient.
- Manage to conclusion all medical only and lost time claims with a keen emphasis on getting injured employees back to work as soon as possible.
- Manage files with an emphasis on file quality (including timely contact and proper documentation), maximizing internal resources, and achieving a positive end result by returning injured party to work. Aggressively pursue claim resolution opportunities.
- Utilize the ACOEM as a basis to determine appropriateness of medical treatment.
- Upholds applicable state and federal workers’ compensation disability regulatory requirements.
- Coordinates medical treatment and associated diagnostic testing with TPA.
- Provides assessment, planning, implementation, and evaluation of patient’s progress and ensures injured worker is on a pro-active treatment plan.
- Coordinates and assigns field nurses to attend doctors, other providers, and attorney’s visits.
- Coordinates hospital discharge planning conferences with the TPA for the purpose of determining appropriateness of care and developing an effective long-term care strategy.
- Case Manager will work with employer, injured worker, provider and TPA to expedite return to work.
- Obtain job description and discuss job modifications required to ensure a prompt return to work.
- Identify cases requiring task assignments to field case managers, coordinate with TPA and supervisor.
- Document each phase of activity in a timely and appropriate manner.
- Perform weekly case reviews with the W/C, monthly case reviews with TPA and quarterly with Medical Director.
- Explaining physician’s and therapists’ instructions, and answers any other questions the claimant may have in an effort to facilitate his/her return to work.
- Develop medical management strategy and give the provider information necessary to facilitate a return to work plan.
- Coordinates with medical providers and suggest cost effective treatment alternatives, when appropriate.
- Monitors effectiveness and efficiency of medical treatment.
- Tracks and reports injury type and monitors cost of medical care.
- Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness.
- Using clinical skills to help coordinate the individual’s treatment program while maximizing cost containment.
- Implements care such as facilitating the delivery of durable medical equipment and nursing services. Devises cost-effective strategies for medical care.
- Discuss medical information and disability status with TPA and integrate into overall strategy to ensure appropriateness of indemnity payments.
- Coordinates care with physicians and staff in ensuring that all paperwork is filed in a timely fashion.
- Minimum of five (5) years full time equivalent of clinical experience in a Urgent Care system preferred.
- Minimum of 3-5 years’ experience in Case Management or Workers compensation.
- Ability to explain medical conditions and treatment plans to the patient, family members, along with the TPA.
Job Type: Full-time
Salary: $18.00 to $28.00 /hour DOE
Full benefits package including medical, dental, vision, PTO, 401K
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