Telephonic Case Manager (New Jersey License required) Job at Coventry WCS
Company Overview:
Perks: Full and comprehensive benefits program, 24 days of paid vacation/holidays in your first year plus sick days, home office equipment including laptop and desktop monitor, Employee Assistance and Referral Program, and hands-on workers’ compensation case management training.
Join our compassionate team and help make a positive difference in an injured person’s life. As a Telephonic Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will:
The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
Job Description:
This is a full-time, flexible work from home position and can be located anywhere in the U.S.
Compensation: Competitive salary.
Perks: Full and comprehensive benefits program, 24 days of paid vacation/holidays in your first year plus sick days, home office equipment including laptop and desktop monitor, Employee Assistance and Referral Program, and hands-on workers’ compensation case management training.
Join our compassionate team and help make a positive difference in an injured person’s life. As a Telephonic Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will:
- Maintain a thorough knowledge and understanding of medical case management practices and HIPAA guidelines in the health care industry.
- Responsible for ensuring appropriate medical services and continuity of care for injured workers.
- Establish and maintain communications with attending physicians, claims adjusters, injured workers, and employer.
- Coordinate medical needs and schedule appointments for appropriate assessment and follow-up until maximum medical improvement is achieved.
- Update adjuster, client, and injured worker in timely and professional manner.
- Schedule and precertify all necessary medical appointments with providers and ancillary services.
- Communicate work status with injured worker, employer and claims adjuster.
- Transcribe, document and maintain employee medical history in Pyramid database using approved format.
- Attend Team Meetings and Case Management meetings as scheduled.
- Review requests for specialty services and direct In Network when available (define service to be provided; research network providers; direct patients accordingly)
- Communicate network negotiation/recruitment needs to Provider Services, Bill Processing and MCCI departments.
- Attend Field Case Management visits when necessary.
- Monitor and track Disability Management and Plans on all cases.
- Maintain and update Case Review diary on all cases.
- Monitor Time Management when it applies to a client.
- Responsibilities may vary dependent upon specific client requirements.
- EDUCATION: Current New Jersey Registered Nurse (RN) or Licensed Practical Nurse (LPN) License
- EXPERIENCE:
- 2-4 years previous Workers’ Compensation Case Management experience
- 2 years Medical/Surgical or other clinical nursing experience
- PC proficiency: MS Office (MS Word & Excel)
- Understand and adheres to policies and procedures both Medical and Administrative, and operates within the scope of job responsibilities
- Internet: Must have reliable internet.
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