Case Management Associate

PRIMARY PURPOSE: To access and assign workers compensation, disability and liability cases applying current policies and procedures per state workers compensation laws; and to increase efficiency of operation by providing general customer support duties and supporting the medical staff in a team environment.

ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Accesses and assigns cases for medical case management, utilization review and clinical consultation.
• Provides accurate information to callers based on customer requests; triages telephone calls between utilization review, clinical consultation and telephonic case managers.
• Enters new claims data into the claims management system accurately; maintains data integrity.
• Supports clinical staff through the completion of components of the case management and utilization review process.
• Schedules diagnostic tests and physician appointments as assigned.
• Provides channeling services for injured workers, employers and claims examiners by directing into PPO network for treatment.
• Gathers statistics for record keeping and provides reports as required.
• Ensures by confirmation that fax forms and filings required by regulatory agencies have been received; distributes, faxes, mails and copies incoming and outgoing correspondence.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports other units as required.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing
Associate's degree or two (2) years of college preferred.

Experience
One (1) year of administrative experience required. Customer service experience in a medical field preferred. Worker's compensation, disability and/or liability claims processing experience preferred.

Skills & Knowledge

• Knowledge of medical and insurance terms
• Knowledge of ICD 9 and CPT coding systems
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills; detail-oriented
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

TAKING CARE OF YOU BY

• Offering a blended work environment.
• Supporting meaningful work that promotes critical thinking and problem solving.
• Providing on-going learning and professional growth opportunities.
• Promoting a strong team environment and a culture of support.
• Recognizing your successes and celebrating your achievements.
• Thrives when everyone is working towards the same vision/goals.
• We offer a diverse and comprehensive benefits package including:
  • Three Medical, and two dental plans to choose from.
  • Tuition reimbursement eligible.
  • 401K plan that matches 50% on every $ you put in up to the first 6% you save.
  • 4 weeks PTO your first full year.

EXT STEPS

If your application is selected to advance to the next round, a recruiter will be in touch.