Sr. Medical Case Manager

Responsibilities

• Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services.
• Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW.
• Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention.
• Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians.
• Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly.
• Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services.
• Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual.
• May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases.
• Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product.
• Reviews cases with supervisor monthly to evaluate files and obtain directions.

Qualifications

• Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted.
• Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity.
• Demonstrated ability to handle complex assignments and ability to work independently is required.
• Effective oral and written communication skills are required.
• Thorough understanding of jurisdictional WC statutes.
• Advanced knowledge to exert positive influence in all areas of case management.
• Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned.
• Highly skilled at promoting all managed care products and services internally and externally.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.
• Minimum of 1 nationally recognized Certification from the URAC list of approved certifications.
• Must be able to travel as required.

About the Role

We’re looking for an RN with a passion for case management to join our team!

Candidates must be based in one of these California areas: San Fernando, Van Nuys, Santa Clarita, Granada Hills, Panorama, Valencia, Oxnard, Westlake Village, Palmdale, or Chatsworth.

Benefits

Includes competitive base pay, bonus/incentive pay and other performance-based rewards, if applicable. A well-rounded benefits package that encourages wellness and helps our employees to be an educated healthcare consumer. The core benefits offered include: Medical, Dental and Vision Plans Prescription Drugs HSA, HRA, and FSA Accounts Paid Holidays, Vacation and Sick Leave 401(k) Retirement Plan Tuition Assistance Paid Parental Leave Supplemental Health Benefits Other Benefits currently available at no cost include: Enhanced Mental Health Support Virtual Physical Therapy Caregiving Services Life Assistance Program.