Medical Management Liaison
Medical Management Liaison
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Job Description
Overview
The Medical Management Liaison position reports directly to the Director Medical Case Management. This position provides daily administrative support to professional Registered Nursing staff increasing production in the areas of Early Intervention Case Management and Utilization Review. This position will assist the nursing staff with Case Management (CM) and Utilization Review (UR) clerical duties.
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully the employee must be able to perform efficiently and effectively each of the following essential functions. Reasonable accommodation may be made for individuals with disabilities.
The functions of this job include but are not limited to:
- Intake prioritizing and timely processing of new Case Management referrals.
- Monitors collects processes and distributes all types of correspondence accordingly. Reports issues with incoming/outgoing correspondence immediately.
- Enters/uploads reports and clear notes into the CM Software Application System.
- Makes timely pertinent phone calls to obtain medical reports treatment plan and RTW related information/reports to provide to the Case Management Nursing Staff.
- Transfers any/all calls where there is clinical information being provided (or a clinically related question surfaces) to a registered nurse for response Licensed staff are always available to assist nonclinical staff while they are attempting to obtain information.
- Schedules Injured Worker appointments as appropriate and under the direction of clinical staff.
- Types injured worker appointment letters and other pertinent letters as requested by and under the oversight of a registered nurse.
- Maintains ongoing nonclinical communications collaborates with pertinent parties related to claims that are open to Case Management and to manage the Utilization Review process or for other administrative tasks as needed.
- Process Utilization Review requests: performs data entry functions reviews multiple criteria to determine eligibility of treatment requests approves treatment requests based on authority level refers treatment requests to a clinical resource or sends appropriate response level.
- Coordinates with claim adjusters or nurses to validate claims or clinical information respectively to make decisions related to eligibility of treatment requests.
- Prioritizes treatment requests based on review type and ensures jurisdictional timeframes and or department turnaround times are met.
- Appropriately documents all systems to reflect critical thinking and actions taken in response to treatment requests.
- Ensures the privacy and security of Protected Health Information (PHI).
- Performs other administrative tasks and functionally related duties as assigned by clinical review nurses nurse case managers or supervisor.
- Makes administrative decisions only completes appropriate actions functioning under the direction of clinical staff and the Manager Medical Case Management and within agreed upon limitations.
- Responds to general customer service questions or directs the caller to the appropriate person or department.
- Training and oversight of other Medical Management Liaisons and Assistants.
Qualifications
QUALIFICATION REQUIREMENTS:
- To perform this job successfully an individual must be able to perform each essential duty satisfactorily.
- Knowledge of medical terminology CPT and ICD codes strongly preferred.
- Good typing skills basic understanding of business technology and ability to learn new procedures quickly.
- Professional telephone demeanor and good oral and written communication skills.
- Ability to take direction think critically and make decisions.
- Selforganized detail oriented and be able to multitask and work well under pressure in a fastpaced environment.
- Ability to work in a team environment.
1. EDUCATION and/or EXPERIENCE:
- High school diploma or equivalent required.
- Computer skills required with knowledge in utilizing Outlook Microsoft Word Excel and other databases.
- Prior medical assistant type experience and/or some knowledge of medical terminology.
- Minimum 12 years Workers Compensation experience or experience in a healthrelated service field is helpful.
- Bilingual a plus.
2. LANGUAGE SKILLS
Ability to write letters memos and reports that conform to prescribed style format and grammatical correctness. Extensive clear professional and tactful communications required via writing reading telephone calls note taking letter writing memoranda etc. Must be able to follow instruction and pay close attention to detail.
3. MATHEMATICAL SKILLS
Basic mathematical and ability to calculate figures and amounts helpful.
4. REASONING ABILITY
Ability to define problems collect data establish facts and draw valid conclusions.
The salary range for this role is $19$22 per hour. This range is only applicable for jobs to be performed in Fresno California.
Base pay offered may vary depending on but not limited to education experience skills geographic location travel requirements sales or revenuebased metrics. This range may be modified in the future.
#AmTrust
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans Life Insurance including eligible spouses & children Health Care Flexible Spending Dependent Care 401k Savings Plans Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race ethnicity gender sexual orientation culture religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds skills and perspectives of its workforce it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative enabling us to attract retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company how we operate and how we see our future.
Employment Type
Full-Time
