Job Description
Job Title: Medical Case Manager
Reports To: Supervisor or Manager
Department: Operations
Date: January 2023
Summary
Works collaboratively with clients, injured workers and insurance carriers to provide case management services to ensure appropriate medical treatment and facilitate timely return to work.
Essential Duties:
- Understands and demonstrates the ability to apply Eagle One™ case management protocols
- Works collaboratively with management, colleagues and account representatives to problem solve on complex cases, claim barriers and on resolution planning.
- Provides initial and ongoing analysis of injury, diagnosis and ongoing medical treatment throughout the claim duration. Determines and documents appropriateness of medical treatment based on disability guidelines.
- Formulates return to work projections and works in collaborative nature with injured workers, providers, therapists and employers to facilitate timely return to work to prevent lost time.
- Delivers timely, consistent and exceptional service to our clients
- Demonstrates ability to work with various personalities and embraces all of the company core values
Essential Responsibilities:
- Effectively manages a caseload of 22-25 active field case management files if full field, 45-55 telephonic case management files, or 35-45 if mixed TCM/FCM depending on complexity
- All full time medical case managers are required to bill a minimum of 40 hours per week
- Remains highly organized in managing day to day and weekly activities including, but not limited to, prioritizing and scheduling of appointments and completion of a to do list
- Attends and participates in all mandatory meetings and in-services
- Communicating timely through regular updates and reporting to clients and insurance carriers on medical progression of a claim
- Responsible for maintaining a complete medical file which is kept in chronological order with no duplication of information in a paperless format
- Utilizing critical thinking skills to provide cost-effective recommendations for care and return to work to the clients we serve
- Provides expert consultation for interpretation of medical information and how it impacts the case
- Adheres to jurisdictional rules and regulations and applies to each case as appropriate
- Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within driving range per protocols.
Qualifications
To perform this job successfully, an individual must be detail-oriented with exceptional communication and interpersonal skills.
Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. 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:
- Active RN licensure in state of employment
- Bachelor’s Degree preferred
- Additional certifications a plus (i.e. CCM, CDMS, CLNC)
Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions.
Computer Skills:
To perform this job successfully, an individual should have knowledge of Microsoft Windows/Office (Word, Excel and Outlook),
be able to navigate the internet for the purpose of research and have a general/overall working knowledge of computer navigation. Typing skills of 45+ wpm
Professional Skills:
- Knowledge of workers’ compensation jurisdictional rules/regulations a plus
- Ability to work in a fast-paced environment
- Strong organizational skills a must
- Excellent written and verbal communication skills
- Excellent customer service skills required
- Previous case management experience a plus
- Clinical experience in an orthopedic or occupational health setting a plus
- Bilingual a plus
- Valid driver’s license and ability to drive to/from appointments if hired as a field case manager
- Competency:
- To perform the job successfully, an individual should demonstrate the following competencies:
- Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.
- Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
- Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
- Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
- Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
- Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
- Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
- Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
- Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
- Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
- Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
- Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
- Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
- Supervisory Responsibilities: This job has no supervisory responsibilities.
- Work Environment:
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
- Physical Demands:
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- The employee must frequently lift and/or move up 10 to 15lbs pounds.
- While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear (type for 5-8 hours per day). The employee is frequently required to stand; walk; sit and reach with hands and arms.
(Sit at a computer 6-8 hours per day, walk to and from appointments, and sit in a car while traveling up to 4 hours). Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.
Company Description
Contact Dawn Stark, HR Coordinator
dstark@eagleonecms.com
Great Benefits
Paid Holidays, M-F, weekends Off
Contact Dawn Stark, HR Coordinator dstark@eagleonecms.com Great Benefits Paid Holidays, M-F, weekends Off
