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AI Summary
The Telephonic Case Manager assesses and analyzes medical and vocational information to facilitate rehabilitation and a timely return to work for injured employees. They act as a liaison between patients, employers, medical providers, and adjusters to coordinate care and monitor progress.
Guardian Managed Care Solutions, a division of Charles Taylor TPA is a highly successful global provider of professional services to the insurance industry. We are seeking a dynamic Telephonic Case Manager to join our Third-Party Administration (TPA) to support a fast-paced, multi-jurisdictional, national workers compensation account. This is a fully remote position in the U.S.
Job Description
Summary
The Telephonic Case Manager position is responsible for assessing and analyzing information pertinent to injured employees to evaluate the medical and vocational needs required to facilitate the patient’s rehabilitation in order to promote appropriate and timely return to work. Acts as a liaison between patient/family, employer, provider(s), healthcare personnel, adjusters, and attorneys involved in workers compensation claims.
The Telephonic Case Manager position is responsible for assessing and analyzing information pertinent to injured employees to evaluate the medical and vocational needs required to facilitate the patient’s rehabilitation in order to promote appropriate and timely return to work. Acts as a liaison between patient/family, employer, provider(s), healthcare personnel, adjusters, and attorneys involved in workers compensation claims.
Essential Duties & Responsibilities
- Obtains medical history of the injured employee and a signed medical release form when appropriate for medical care coordination purposes
- Requests, obtains, and reviews medical records
- Assesses and analyzes an injured employee’s medical and vocational status
- Develops a plan of care to facilitate the patient’s appropriate and timely return to work; coordinates with the employer when appropriate
- Interviews patients to provide ongoing case management services
- Communicates telephonically and electronically with patients, medical providers, adjusters, attorneys, and vendors
- Schedules appointments for implementation and follow-up of treatment plans
- Coordinates and monitors progress and completion of vendor referrals, consultations, and therapeutic services for patients
- Ensures transportation and translation are available for the injured employee to attend medical appointments when appropriate
- Ensures all injured employees’ and employers’ concerns are addressed by the physicians
- Ensures injured employees understand diagnosis of their injury/illness, and any instructions and recommendations regarding treatment when appropriate
- Provides consistent monitoring, contact, support, and education to injured employees to monitor patients’ progress toward desired outcomes, promote compliance, motivation, and address issues as they arise when appropriate
- With adjuster approval, coordinate necessary medical and rehabilitative care for injured employees including but not limited to appointments, medications, surgery, therapies, diagnostics, equipment, transportation, translation etc.
- Establishes effective rapport with all professions involved in the injured employees’ rehabilitation process to facilitate treatment, optimal care, and successful return to work
- Provides comprehensive documentation detailing case management services, the injured employees’ progress with treatment plan, return to work status, maximum medical improvement, and significant events that meets company standards for content and format
- When appropriate coordinate return to work issues with the employer, to include job site analysis, ergonomic evaluation, etc. and present to the physician for review
- Maintains a working knowledge of up-to-date medical information including but not limited to medications, procedures, equipment, therapies, treatments, their uses, contraindications, side effects, etc. and provides research information to adjusters to assist with determinations of medical necessity and appropriateness
- Applies all laws and regulations relative to the provision of case management and rehabilitation services in the geographic region assigned
- Testifies as required to substantiate any relevant case work or documentation
- Timely completion of time and expense reporting per company guidelines
- Works closely with team of case managers and support staff
Requirements
- Must hold an unrestricted, multi-state compact Registered Nurse (RN) license
- Must hold or be willing to obtain Registered Nurse (RN) licenses in the following states: California, Hawaii, Illinois
- Must hold at least one of the following credentials: CCM, CRRN, CDMS, COHN, CRC
- Must hold or be willing to obtain Rehabilitation Supplier/Professional credentials for the following states: Georgia, North Carolina
- Must maintain all applicable credentials, licensure, and/or certification(s) for case management
- Ability to work independently, within a team environment, and deal effectively with multiple tasks simultaneously
- Must possess strong professional communication, organizational, and interpersonal skills when interacting verbally and in writing
- Strong customer service skills
- Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
- Computer literacy, daily usage of MS Office Product Suite, i.e., Word, Excel, PowerPoint, Teams, and claims systems
- Ability to proofread typed material for grammatical, typographical, or spelling errors
- Ability to change and adapt work activities frequently while prioritizing projects
- Knowledge of operating standard office equipment i.e. computer, fax, copier, scanner, phone, etc.
Additional Experience (preferred but not required)
- Telephonic case management experience at a Third-Party Administrator (TPA), in the medical field, or workers compensation industry
- Experience with the statutes and rules of workers compensation for a fast-paced, multi-jurisdictional, national workers compensation account
- Bilingual a plus
Values
Demonstrate and role model the Charles Taylor six Values by ensuring a Supportive Environment, upholding Excellence in People, focusing on Partnership with Clients, delivering High quality Work, promoting Group-wide Entrepreneurship and having an Appetite for Change.
Demonstrate and role model the Charles Taylor six Values by ensuring a Supportive Environment, upholding Excellence in People, focusing on Partnership with Clients, delivering High quality Work, promoting Group-wide Entrepreneurship and having an Appetite for Change.
Equal Opportunity Employer
Here at Charles Taylor we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation.
Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive and diverse culture and environment which we are proud to be a part of at Charles Taylor.
Here at Charles Taylor we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation.
Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive and diverse culture and environment which we are proud to be a part of at Charles Taylor.
About Charles Taylor
Charles Taylor is a leading international provider of professional claims and insurance services to clients around the world. Charles Taylor TPA is the fastest growing division within the Charles Taylor Group. Charles Taylor TPA handles a variety of workers’ compensation, P&I, and general liability claims.
If you are seeking a place where you can achieve great things for great clients in a supportive and collaborative environment, then Charles Taylor is the place for you.
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