Risk & Insurance Management Services, Inc.

Compensation

Full Description

Summary Works collaboratively with clients, injured workers, employers 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 EagleOne™ 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) 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: •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 Additional Competencies: •Customer Service •Oral Communication •Teamwork •Ethics •Organization •Adaptability •Punctuality •Dependability •Initiative •Professionalism 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 to 10 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. The employee is frequently required to stand; walk; sit and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.