Senior Telephonic Case Manager
Senior Telephonic Case Manager
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The Senior Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate costeffective medical treatment of injured employees with the goal of optimal medical improvement. The TCM is responsible for disability management including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This position will work full remote.
KNOWLEDGE AND SKILLS:
- Excellent verbal and written communication skills.
- Strong interpersonal and relationship building skills.
- Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines.
- Highly skilled in Excel PowerPoint and other Microsoft Office products with a proven ability to learn other technology tools.
- Ability to analyze complex medical information and make sound decisions
- Strong organizational and time management skills to effectively prioritize tasks
- Ability to work independently and collaboratively in a multidisciplinary team environment to manage priorities and meet deadlines
- Proficient understanding of traumatic injuries related disabilities and potential medical complications
- Indepth understanding of medical terminology anatomy and physiology.
- Strong analytical and critical thinking skills.
- Proficiency in researching interpreting and analyzing medical records.
- Familiarity with legal concepts and processes related to Casualty and Workers Compensation claims (preferred).
MAJOR DUTIES/RESPONSIBILITIES OF THE JOB:
- Conduct comprehensive medical assessments including detailed reviews of medical records accident reports and related documentation.
- Analyze and interpret medical histories diagnostic tests and treatment plans to assess the nature extent and longterm impact of injuries.
- Review and analyze large loss risktransfer contracts and provide expert medical consultation in alignment with company goals and objectives.
- Work collaboratively with crossfunctional teams to execute claim strategies and drive optimal claim outcomes.
- Act as a crossdisciplinary technical expert to provide oversight and support for complex and large loss claims.
- Demonstrated experience in effectively collaborating with vendors to achieve project goals and partner on solutions.
- Proficient in following up on root cause analyses to identify issues and implement corrective actions.
- Strong analytical skills with the ability to interpret data and trends to drive informed decisionmaking.
- Capable of creating and outlining workflows to streamline processes and enhance operational efficiency.
EDUCATION AND EXPERIENCE:
- Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed.
- Certified Case Manager (CCM) certification a plus
- Minimum 3year experience in Workers Compensation Case Management required.
- Bilingual in Spanish a plus
- Expertise with MS Officeproducts
Required Experience:
Manager
Employment Type
Full-Time
