Telephonic Case Manager (WC)
GENERAL SUMMARY
: Responsible for telephonically assessing; planning; implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient's appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
ESSENTIAL RESPONSIBILITIES
- Works telephonically with workers' compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services.
- Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee; provider(s); and the employer.
- Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee's short and long-term outcomes.
- Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee's best interest, addressing treatment alternatives, quality and cost effective health care and rehabilitative services.
- Assists the injured employee by providing medical and disability education and coordinating on-site job analysis; work conditioning; functional capacities; and ergonomic evaluations.
- Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee's functional capacity to ensure the injured employee's safe and timely return to work.
- Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches; over or under utilization; inappropriate care; effective treatment; permanent or temporary loss of function; failed or premature return to work; and non-compliance.
- Adheres to all appropriate privacy, security and confidentiality policies and procedures.
- Performs other duties as assigned.
Qualifications:
JOB SPECIFICATIONS
- RN with current state license required.
- Previous (3 or more years) general clinical experience required.
- Bachelor's degree or equivalent experience preferred.
- CCM, CRRN, COHN, or CDMS. These designations are required where dictated by state law.
- Previous workers compensation case management.
- Strong problem solving analytical skills.
- Demonstrated communication, organizational, and interpersonal skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: New Haven, CT, US
Organization: 43000 - CHC Workers Compensation
Schedule: Full-time
Job Posting: 2012-08-15 00:00:00.0
Job ID: 1210812 - Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee's short and long-term outcomes.