GENERAL SUMMARY
Responsible for consulting with assigned customers on the development of effective strategies and action plans relating to cost-effective solutions in medical management and return-to-work programs. Serves as a liaison with employees, employers, physicians, vendors, and adjusters. MUST BE BILINGUAL.
ESSENTIAL RESPONSIBILITIES
- Consults with the customer to develop effective strategies and action plans relating to cost-effective solutions in medical management and return-to-work programs.
- Conducts onsite formal presentations to educate the customer on best practice approaches to return-towork programs, utilization and effectiveness of current programs, and alternative cost-effective solutions.
- Works with the medical consultant to assess the workers’ compensation population with significant comorbidity and refers identified cases to a case manager to minimize the impact on the employee’s health and injury.
- Supports the customer in constructing medical management measurements for County Board of Commissioners presentations by using knowledge of managed care practices.
- Communicates with providers on the effectiveness of the provider network to improve the medical management of the workers’ compensation population.
- Serves as a liaison with employees, employers, physicians, vendors, and adjusters.
- Provides assistance in interpreting various laws, rules, policies and procedures affecting return-to-work programs.
- Compiles, documents, and maintains all appropriate documentation in appropriate database.
- Performs other duties as assigned.
Qualifications:
JOB SPECIFICATIONS
- Licensed Practical Nurse (LPN) with active state license required. Registered Nurse (RN) with active state license preferred.
- Previous (3 or more years) clinical practice experience required.
- Bachelor’s degree or equivalent experience preferred.
- Extensive knowledge of workers’ compensation and managed care.
- Strong problem solving and analytical skills.
- Ability to work independently.
- Demonstrated PC skills (may require the use of a laptop computer).
- Regular local travel may be required.
- Demonstrated communication, interpersonal, and organizational 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: Carrollton, TX, US
Organization: 43000 - CHC Workers Compensation
Schedule: Full-time
Job Posting: 2012-12-28 00:00:00.0
Job ID: 1211986