Medical Field Case Manager

Requisition ID
2017-2075
# of Openings
1
Category
Operations
US-FL-Sarasota

Overview

The Medical Field Case Manager accepts assignments from an employer, insurance company, or other responsible party regarding an injured or disabled individual and assesses the information provided to determine the individual’s specific health care needs in order to facilitate a timely return to work. The Medical Field Case Manager is responsible to ensure the patient is receiving quality care that is appropriate and necessary and anticipates the patient’s future health care needs and aids in ensuring the proper mechanisms are put in place to meet maximum rehabilitation in the most efficient and cost effective way possible. The Medical Field Case Manager develops and presents treatment plans covering the above stated goals and secures provider acceptance to the plan.  Acting as a liaison between the patient,family, employer, provider(s), insurance companies and/or healthcare personnel the medical field case manager communicates all activity through written reports and verbal updates to the referring party and is responsible for timely service delivery and quality reporting in compliance with URAC Standards and represents ExamWorks Clinical Solutions in a professional and customer oriented manner. 

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Assesses and analyzes injured worker's medical and/or vocational status and develops a viable, realistic action plan for maximum medical improvement from date of referral to closure.
  • Meets with individuals in their homes, work-sites, physician's or therapist's office to provide ongoing case management services.
  • Assesses the assigned individual to ensure appropriate safety measures are in place.
  • Implements, calculates and documents cost savings measures.
  • Manages progress towards desired outcomes.
  • Responsible for maintaining regular communication with the injured worker, medical providers, attorneys, employers, claims professionals, and ECS management.
  • Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care.
  • Applies all special service instructions required by customers/accounts.
  • Appropriately applies all laws and regulations to the provision of rehabilitation services.
  • As needed, testifies to substantiate any casework or reports that may be deemed relevant in litigated cases.
  • Evaluates outcomes and case goals.
  • Prepares reports and other required documentation for casework activities.
  • Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment.
  • Upholds applicable state and federal regulatory requirements that govern workers' compensation disability.
  • Substantiates case activities carried out/services rendered in all activity reports completed.
  • Accurately reports all case activity and billable hours in accordance with client-specific guidelines and consistent with company billing practices.
  • Meets weekly billing requirements (35-40 hours per week for full-time Case Managers).
  • Attends all scheduled conference calls as mandated by management.
  • Maintains any required credentials and adheres to all codes of ethics required by these credentials.
  • Performs various professional duties as assigned by management.

Qualifications

PROFESSIONAL COMPETENCIES

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

 

EDUCATION AND/OR EXPERIENCE

  • Associates Degree or Diploma in nursing is acceptable; a bachelor’s degree in nursing and/or health related field preferred and current, active, and unrestricted licensure as a health professional (RN).
  • 5 years case manager experience preferred.

 

QUALIFICATIONS 

  • Minimum 2 years clinical nursing background.
  • Knowledge of the disability and workers' compensation industry including rules and regulations and an understanding of clinical procedures and all processes involved in the delivery of quality health care to an injured worker.
  • Practice case management within the scope of his/her licensure (based on the standards of the discipline).
  • Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
  • Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
  • Knowledge of current laws and regulations that govern delivery of rehabilitation services.
  • Knowledge of human behavior and performance.
  • Ability to demonstrate strong customer service knowledge including needs assessment, meeting quality standards for services and evaluation of customer satisfaction.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Must be able to work independently, prioritize work activities and use time efficiently.
  • Ability to concentrate and multitask in a fast paced work environment.
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team -oriented environment.
  • Must be able to work well under pressure and/or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.
  • Must possess a valid driver’s license.
  • Must provide proof of personal automobile liability insurance with liability limits of no less than Five Hundred Thousand and No/100 Dollars ($500,000.00) per occurrence.
  • Must be able to operate a vehicle and have the ability and willingness to travel for task and/or field case management visits within assigned geographic areas.
  • Must possess excellent skills in English usage, grammar, punctuation and style.
  • Bilingual in English and Spanish preferred.  
  • Demonstrates reliability and abides by the company attendance policy.
  • Must maintain a professional and clean appearance at all times consistent with company standards.

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