Job Description

Level: Experienced
Job Location: Involuntary Remote TMC - Remote, SC 29486
Position Type: Full TimeEducation
Level: High School Diploma or GED
Salary Range: $85,000.00 - $98,000.00 Salary
Travel Percentage: None
Job Shift: Day
Job Category: Admin - ClericalPOSITION SUMMARY: The medical case manager provides telephonic 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, and staff. Work well independently and set priorities.
Primary responsibilities include:
- Provide telephonic outreach for assessment and follow-up for case communication and coordination to include assessing, planning, implementing, coordinating care
- Conducts and documents initial assessment with the injured worker, employer, and provider and maintains regular contact with all parties involved to facilitate communication and formulate a clinical case plan
- Responsible for coordination of contact with provider, claimant, RTW contact, and claims examiner
- Reviews case records and reports, collects and analyzes data, evaluates client's medical status, and defines needs and problems in order to provide proactive case management services
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- Assessment of medical records for appropriateness of treatment and level of care being provided. Referral to the Medical Director if appropriate within the established timeframes
- Facilitate timely return to work date coordinating RTW with the claimant, employer, and physicians
- Maintains contact and communicates updated activity with all parties involved with the case
- Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and, identify potential issues and promote positive treatment outcomes. Negotiate treatment plan with treating physician
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- 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 policy 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
- Other job duties as assigned
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- EQUIPMENT OPERATED/USED:
- Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications
- Essential Tools: Pens, pencil, computer, Keyboard
- Essential Vehicles:  N/A
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- SPECIAL EQUIPMENT OR CLOTHING:
- Professional attire adhering to the Company Dress Code
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Qualifications

Experience:
- 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 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 and negotiating  skills
- Excellent interpersonal skills and excellent organizational skills.
- Proficient with Microsoft Office applications including Word, Excel, and Power Point
- Education:
- 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