Telephonic Medical Case Management; Workers

Overview

Fresno Office - Fresno, CA 93727

Salary Range: $85,000.00 - $98,000.00

Position Type: Full Time

Job Shift: Day

Education Level: High School Diploma or GED

Travel Percentage : None

Category: Admin - Clerical

Telephonic Medical Case Manager

This is a remote position preferably in Fresno, CA. Hours will be 8 am - 5:30 pm Pacific time

Must have an unrestricted nursing license. CA experience preferred.

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.

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 of care
• Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan
• Coordinate contact with provider, claimant, RTW contact and claims examiner
• Review 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
• Assessment of medical records for appropriateness of treatment and level of care being provided. Referral to the Medical Director if appropriate within the established time frames
• 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

• 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

SPECIAL EQUIPMENT OR CLOTHING:

Professional attire adhering to the Company Dress Code

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 Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case Manager (CCM) license required
• CCM, CMCN, CPHUR, CPDM, COHN or CDMS certification preferred

Experience:

• Three or more years of diverse clinical experience in acute care
• Two or more years of medical case management or managed care experience, Worker’s Compensation background preferred
• Knowledge of utilization management, quality improvement, discharge planning, and or cost management.
• Ability to solve practical problems and deal with a variety of variables.
• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
• Excellent interpersonal skills and excellent organizational skills.
• Ability to set priorities and work independently is essential
• Proficient with Microsoft Office applications including Word, Excel, and Power Point

1. MENTAL EFFORT

a. Reasoning development:

Follow one- or two-step instructions; routine, repetitive task.

Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.

Follow written, verbal, or diagrammatic instructions; several concrete variables.

X Solve practical problems; variety of variables with limited standardization; interpret instructions.

Logical or…