Nursing - Case Manager

PR - $30 - $33
Job Description:
Provides telephonic case management for workers compensation cases involving lost time and extensive medical care. Acts as a liaison between claimants, providers, external claim representatives, clients and attorneys, as needed, to manage the appropriate level of care.

Responsibilities:

• Performs selected medical appropriateness protocol procedure activities including telephone interviews and collection of information from claimants, providers and the client.
• Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently.
• Evaluates and coordinates the treatment plans proposed by providers, in accordance with established HCS protocols. Authorizes medical treatment and associated diagnostic testing on assigned claims.
• Acts as liaison with client to identify issues and problems relating to medical care, treatment plans, and claim processing and forwards concerns to appropriate parties, when necessary.
• Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment.
• Reviews and identifies claims involving complex injuries/treatment plans and refers them to a nurse case manager.

Qualifications:
Education/Experience: Prefers a bachelors degree. Requires a minimum of two years business experience, preferably in a medical support related position or health insurance environment.

Knowledge:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
• Requires knowledge of medical terminology. Prefers knowledge of understanding of case management, philosophy and process.

Skills and Abilities:

• Strong typing, data entry and numeric keypad skills necessary. Must be comfortable using a calculator for simple math calculations.
• Analytical and Problem Solving Skills, Customer Focus, Interpersonal and Client R
• elationship Skills, Communication (both verbal and written) and Organizational Skills, Decision Making, Flexibility/Adaptability.