Medical Case Manager
- Irving, TX
What you'll be doing
- Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner. Assessment of medical records for appropriateness of treatment and level of care being provided. Evaluate treatment requests and review clinical information received with treatment protocols and guidelines, identify medical necessity and refer to the medical director if appropriate within the established timeframes. Direct authorized medical treatment within the PPO, MPN or to strategic business partners whenever possible. Work with treating physicians and return to work contact for facilitating early return to work. Utilize the established template and documentation standards. Maintain minimum billing standards. Work closely with the claims examiner to update and advise of case status and potential problems. Other duties as assigned by supervisor.
What your background should be
- Three or more year's of recent worker compensation experience is required. Strong clinical background in orthopedics, rehabilitation and case management. Strong cost containment background. Good clinical thinking and professional documentation.
Required Schooling / Training
- Graduate of an accredited school of nursing.
Who is the client company
- This is the largest privately held third party administrator in the industry.
- If you are interested in this position, send your resume to firstname.lastname@example.org