York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies Two Years in a Row" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
The Medical Case Manager provides medical and vocational assistance and coordination services to assist injured workers in reaching maximum medical improvement and return to work. The Medical Case Manager facilitates communication between all parties including the injured worker, the adjuster, the employer, treating physician(s) and ancillary providers to assist the injured worker in obtaining prompt and appropriate medical treatment. The Medical Case Manager assesses rehabilitation needs and makes appropriate recommendations. The ultimate goal is for the injured worker to recover and return to work as soon as is medically appropriate. The Medical Case Manager facilitates any temporary or permanent job modifications necessary to allow the injured worker to return to work within the applicable physical restrictions assigned by the doctor. The exact role the Medical Case Manager plays will vary with the injury management model used by each customer. The responsibilities on each case may vary.
ESSENTIAL JOB RESPONSIBILITIES:
- Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services
- Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations); Schedules appointments to avoid delays in treatment by primary care physicians, specialists or ancillary services
- Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved
- Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports
- Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed
- Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim; Work with the treating physician to update any conditions as medical treatment progresses
- Assesses the injured worker and his/her support system and family; Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
- Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment; The job must be consistent with any physical restrictions assigned by the treating doctor; Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force
- Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan
- Maintains constant contact with the adjuster assigned to the file through telephone calls, EMAIL and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer
- Makes appropriate use of Wellcomp physicians for adjuster support, peer-to-peer consultation and as professional resource; Make appropriate use of Wellcomp clinical and information systems staff to deliver exceptional service to direct & indirect customers
- Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties
- Acts as an advocate for the injured worker with all parties while maintaining the injured worker's privacy and safety; Adheres to Wellcomp's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
- Participates in the collection of outcome information and Wellcomp's Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
- Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers' compensation and federal laws that impact the delivery of health care and return to work
- Become proficient in the software used in the department
- Contribute to the success of the company and its posture toward customer service by a positive and professional attitude and by understanding and responding to the needs of our direct and indirect customers; Follows ethical, legal, and regulatory standards
- Performs other duties as assigned
- The Medical Case Manager reports to the Team Manager, Case Management and has no direct reports.
- MA/ BS / BA in Nursing or Associates Degree in Nursing from accredited school with Equivalent Work Experience and a CCM, CIRS, CRRN, COHN or other related designation or;
- BA/BS or MA in related field with a CCM, CDMS, or CRC or other related designation or;
- Current Nursing license and/or certification
- CCM required based on state guidelines.