Oakland, Michigan
Filed Case Manager Job Opening in Oakland, Michigan - Case Management Position Description: We are currently seeking a Field Case Manager (RN) in the Oakland area. Responsible for assessment, planning, plan care coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured client and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.
Key responsibilities will include but are not limited to:
Using skills to help, identify and coordinate the individual treatment plan.
Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the physicians, case managers and treatment team.
Explaining physicians and therapist?s instructions, and answers any other questions the claimant may have in an effort to facilitate his/her return to work.
Working with the physicians and therapists to set up medical assessments to develop an overall treatment plan.
Researching alternative treatment options such as pain clinics, home health care, and work hardening.
Coordinating all aspects of the individual enrollment into the programs, and then monitors his/her progress.
Working with employers on modifications to job duties based on medical limitations and the employee?s functional assessment.
May provide testimony on litigated cases.
Coordinating client appointments and arranges and/or personally escorts him/her to the appointments.
Documenting and reporting all case activity for accurate case management and billing procedures.
Preparing detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed.
Reporting billing hours in accordance with case activity and billing practices.
Maintaining phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.
Compiling a case inventory on a monthly basis for submission to the branch manager to allow for proper billing and to calculate hours.
Completing insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies.
Maintaining the necessary credentials and demonstrates a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole.
Acquiring and maintaining knowledge of developments in the medical case management field.
Keeping abreast of local workers and auto no-fault compensation laws and regulations, as well as other issues related to the case management/managed care industry.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Diploma, Associate or bachelor?s degree in nursing, social work, Allied health, business, behavioral psychology or a bachelor?s degree (or higher) in a health or human services related field required. Masters level and/or advanced study in a health-related field desired.
In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of the persons being served, that requires: 1) A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization; 2) The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and 3) URAC-recognized certification in case management within four (4) years of hire as a case manager. Employee Status and benefits provided to be discussed at the interview.
Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility.
Excellent interpersonal skills and phone manners. Excellent organizational skills.
Must be proficient in Microsoft Office suite with such programs as Word and Excel as well as have experience with internet searches and a comfort level with other software programs.
Ability to set priorities and work independently is essential.
Bilingual speaking ability a plus
Required experience:
Nursing, Social Work, Allied Health, Behavioral Psychology: 1 year
Job Type: Full-time
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