ExamWorks Clinical Solutions is searching for a FieldCase Manager. Registered Nurses are a key component in the healthcare industry. We understand that you have put in many tireless hours, overnights, and weekends providing compassionate care. Here is your opportunity to take off those scrubs and take back your life style. Goodbye working weekends, goodbye working holidays! Sounds too good to be true, but it isn’t!
Our Field Case Manager’s accept assignments from an employer, insurance company, or other responsible party regarding an injured or disabled individual. Once we have that information, you will begin to assess the information provided to determine the individual's specific health care needs in order to facilitate a timely return to work. As a FieldCase Manager, your responsibility is to ensure that the patient is receiving quality care that is appropriate and necessary. In doing so, you will anticipate the patient's future health care needs and aid in ensuring the proper mechanisms are put in place to meet maximum rehabilitation in the most efficient and cost effective way possible. You will also develop and present treatment plans and secure provider acceptance to the plan.
This role is based off of where you live (we are looking for someone in the Bay Area) and will be 75% local travel (a 4 hour round trip at the most) and roughly 25% work from home.
We are offering a sign on bonus!
ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:
Assesses and analyzes injured worker's medical and/or vocational status and develops a viable, realistic action plan for maximum medical improvement from date of referral to closure.
Meets with individuals in their homes, work-sites, physician's or therapist's office to provide ongoing case management services.
Assesses the assigned individual to ensure appropriate safety measures are in place.
Implements, calculates and documents cost savings measures.
Manages progress towards desired outcomes.
Responsible for maintaining regular communication with the injured worker, medical providers, attorneys, employers, claims professionals, and ECS management.
Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care.
Applies all special service instructions required by customers/accounts.
Appropriately applies all laws and regulations to the provision of rehabilitation services.
As needed, testifies to substantiate any casework or reports that may be deemed relevant in litigated cases.
Evaluates outcomes and case goals.
Prepares reports and other required documentation for casework activities.
Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment.
Upholds applicable state and federal regulatory requirements that govern workers' compensation disability.
Substantiates case activities carried out/services rendered in all activity reports completed.
Accurately reports all case activity and billable hours in accordance with client-specific guidelines and consistent with company billing practices.
Meets weekly billing requirements (35-40 hours per week for full-time Case Managers).
Attends all scheduled conference calls as mandated by management.
Maintains any required credentials and adheres to all codes of ethics required by these credentials.
Performs various professional duties as assigned by management.
EDUCATION AND/OR EXPERIENCE
Current, active, and unrestricted licensure as a health professional (RN).
5 years case manager experience preferred. 2 years case management experience required.
Workers' Comp experience ideal.
Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
Knowledge of current laws and regulations that govern delivery of rehabilitation services.
Knowledge of human behavior and performance.
Ability to demonstrate strong customer service knowledge including needs assessment, meeting quality standards for services and evaluation of customer satisfaction.
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
Must be able to work independently, prioritize work activities and use time efficiently.
Ability to concentrate and multitask in a fast paced work environment.
Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
Must be able to maintain confidentiality.
Must be able to demonstrate and promote a positive team -oriented environment.
Must be able to work well under pressure and/or stressful conditions.
Must possess the ability to manage change, delays, or unexpected events appropriately.
Must possess a valid driver’s license.
Must provide proof of personal automobile liability insurance with liability limits of no less than Five Hundred Thousand and No/100 Dollars ($500,000.00) per occurrence.
Must be able to operate a vehicle and have the ability and willingness to travel for task and/or field case management visits within assigned geographic areas.
Must possess excellent skills in English usage, grammar, punctuation and style.
Bilingual in English and Spanish preferred.
Demonstrates reliability and abides by the company attendance policy.
Must maintain a professional and clean appearance at all times consistent with company standards.
Internal Number: 001
ExamWorks, LLC is a leading provider of independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services.
We provide IME services through our medical panel of credentialed physicians and allied medical professionals. Our independent medical review process is fully contained within our private cloud network. Custom portals, applications, workflow enhancements and systems integration are part and parcel of our service, all included for the price of an IME service.
Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
We help our clients in the U.S., Canada, the United Kingdom and Australia manage costs and enhance their risk management processes by verifying the validity of claims, identifying fraud and providing fast, efficient and quality IME services.