Medical Case Manager – Telephonic Case Management

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Conduct telephonic outreach for assessment and follow-up, which includes evaluating, planning, implementing, and coordinating care.

• Perform and document initial assessments involving injured workers, employers, and healthcare providers.

• Maintain consistent communication with all parties to enhance collaboration and develop clinical case plans.

• Coordinate interactions with providers, claimants, return-to-work contacts, and claims examiners.

• Review case records and reports, gather and analyze data, assess medical status, and identify needs and issues.

• Evaluate medical records for the suitability of treatment and level of care.

• Refer cases to the Medical Director when appropriate and within specified timeframes.

• Facilitate the timely return-to-work dates in collaboration with claimants, employers, and physicians.

• Monitor medical appointments via telephone to discuss return-to-work status, treatment plans, potential challenges, and treatment results.

• Negotiate treatment plans with the physicians providing care.

• Fulfill administrative responsibilities, which include productivity, time management, quality assurance, billing, and documentation standards.

• Uphold confidentiality and comply with relevant laws and regulations regarding HIPAA and PHI.

• Execute additional duties as assigned.

⛳️ Requirements

• A Bachelor's degree in nursing, or a Master's degree (or higher) in Nursing, Health, or Human Services, or equivalent relevant experience is preferred.

• An active, unrestricted RN license is required.

• CCM, CPDM, COHN, or CDMS certification is preferred.

• A minimum of three years of varied clinical experience caring for acutely ill patients with multiple medical conditions.

• At least three years of experience in Managed Care and/or Workers' Compensation is required.

• Familiarity with utilization management, quality improvement, discharge planning, and cost management.

• Knowledge of state workers' compensation laws and practices is desirable.

• Strong skills in planning, organizing, conflict resolution, and negotiation.

• Excellent interpersonal and organizational abilities.

• Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.

• Bilingual proficiency is a plus.

• Experience in multiple states, including California, is preferred.

• Professional attire that complies with the Company Dress Code is required.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• Life and Disability Insurance.

• 401(k) Plan.

• Paid Holidays.

• Paid Time Off.

• Referral bonus.

• Fully remote work arrangement.