Reimbursement Case Manager Jobs in Springfield, IL

Provides medical management to workers compensation injured employees, performing case management through telephonic and in-person contact with injured workers and medical providers. Coordinates with employers and claims professionals to manage medical care in order to return injured employee to work.  This position will cover the Springfield area with a travel radius of up to 2 hours. 

Key Responsibilities:  

• Coordinating medical evaluation and treatment
• Meeting with physician and injured worker to collaborate on treatment plan and to discuss goals for return to work
• Keeping employer and referral source updated regarding medical treatment and work status
• Coordinating ancillary services, e.g. home health, durable medical equipment, and physical therapy.   Communicates with employers to determine job requirements and to explore modified or alternate employment. 
• Discusses and evaluates results of treatment plan with physician and injured worker using Evidence Based Guidelines to ensure effective outcome. 
• Documents case management observations, assessment, and plan. 
• Generates reports for referral source to communicate case status and recommendations. 
• Generates ongoing correspondence to referral source, employer, medical providers, injured worker, and other participants involved in the injured worker's treatment plan.  
• May participate in telephonic case conferences.  
• Maintains a minimum caseload of 35 files, and 150 monthly billable hours, with minimum 95% quality compliance.

Required 

• Nursing or medical degree from an accredited institution with an active Registered Nursing license or medical license within the state of practice or states in which case management is performed. 
• 2-4 years of work experience.  
• Responsible for completing required and applicable training, in order to maintain proficiency and licensing requirements. 
• Able to travel to appointments within approximately a 2 hour radius.  
• Intermediate to advanced computer skills; Microsoft Office, Outlook, etc.

Desired:

• Bachelor's degree preferred.  
• Worker's Compensation experience is preferred. 
• Certification in related field preferred. 
• 1-3 years of clinical experience preferred.

Work Traits:

• Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice. 
• Advanced written and oral communication skills, along with organizational and leadership skills. 
• Self-directed and proactively manage assigned case files. 
• Demonstrates strong time management skills.

#LI-CW1

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.

We value inclusion and diversity

Click Here to review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Required 

• Nursing or medical degree from an accredited institution with an active Registered Nursing license or medical license within the state of practice or states in which case management is performed. 
• 2-4 years of work experience.  
• Responsible for completing required and applicable training, in order to maintain proficiency and licensing requirements. 
• Able to travel to appointments within approximately a 2 hour radius.  
• Intermediate to advanced computer skills; Microsoft Office, Outlook, etc.

Desired:

• Bachelor's degree preferred.  
• Worker's Compensation experience is preferred. 
• Certification in related field preferred. 
• 1-3 years of clinical experience preferred.

Work Traits:

• Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice. 
• Advanced written and oral communication skills, along with organizational and leadership skills. 
• Self-directed and proactively manage assigned case files. 
• Demonstrates strong time management skills.

#LI-CW1