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, ensuring effective case communication and coordination, which includes assessing, planning, implementing, and coordinating care.

• Perform and document initial assessments with injured workers, employers, and providers while maintaining consistent communication with all involved parties to develop a clinical case plan.

• Oversee coordination of contact among providers, claimants, return-to-work (RTW) contacts, and claims examiners.

• Review case records and reports, gather and analyze data, assess the client's medical status, and identify needs and issues to deliver proactive case management services.

• Evaluate medical records to ensure the appropriateness of treatment and the level of care provided.

• Refer to the Medical Director as necessary within the designated timeframes.

• Facilitate a timely return-to-work date by coordinating with the claimant, employer, and physicians.

• Maintain communication and provide updates on activities to all parties involved in the case.

• Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plans, identify potential issues, and promote positive treatment outcomes.

• Negotiate treatment plans in collaboration with the treating physician.

⛳️ Requirements

• Diploma, Associate or Bachelor’s degree in Nursing, or a Master's degree (or higher) in Nursing, Health, or Human Services field, or equivalent relevant experience is preferred.

• A current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN), and/or Certified Case Manager (CCM) license is required.

• Preferred certifications include CCM, CMCN, CPHUR, CPDM, COHN, or CDMS.

• A minimum of three years of diverse clinical experience in acute care is necessary.

• At least two years of experience in medical case management or managed care, with a preference for a background in Worker’s Compensation.

• Familiarity with utilization management, quality improvement, discharge planning, and/or cost management is essential.

• Strong problem-solving skills and the ability to navigate various variables are required.

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

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• Life and Disability Insurance.

• 401(k) Plan.

• Paid Holidays.

• Paid Time Off.

• Referral bonus.