Work Comp Case Manager
International Medical Group
IMG is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, ethnicity, national origin, religion, gender, gender identity or expression, sexual orientation, genetic information, disability, age, veteran status, and other protected statuses as required by applicable law.
As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind®
We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers. IMG, located in Indianapolis, IN, is seeking a RN licensed and dedicated Worker's Compensation Nurse Case Manager.
The Worker's Compensation Nurse Case Manager provides case management services to coordinate health care for injured workers, both foreign and domestic. The primary responsibilities of the Worker's Compensation Nurse Case Manager is to evaluate medical treatment and help mitigate risk and exposure with appropriateness and efficiency of the use of health care services, procedures, and facilities. This position will also work as a liaison between the Insured, the insurance carrier and the Insured?s healthcare team to meet the requirements of the work injury jurisdiction in the United States and abroad.
DUTIES AND RESPONSIBILITIES
Reviews medical services for medical necessity.
Direct and/or re-direct claimant to appropriate approved care.
Negotiate discounts with out of network providers.
Direct healthcare team members to utilize alternative care settings when appropriate.
Identify claimant needs by priority, diagnosis, dollar amount and/or high utilization of medical services and coordinate care to satisfy the carrier, insured, provider, claimant, and medical team.
Document information and status in ACM systems and documents.
Participate in the on-call rotation schedule for medical evacuation calls.
Prepare case management reports monthly and as needed.
Use good judgment when evaluating medical cases and confer with Medical Director when appropriate.
Communicate with other members of team as needed and ensure that information is shared appropriately.
Maintain confidentiality and privacy of all protected health information.
Continue education through relevant reading materials, online courses and/or seminars.
Support and participate in Quality Management activities.
Utilize clinical support tools as indicated.
Maintain a working knowledge of the case management process & standards established by URAC and any applicable state or federal regulations as appropriate for job duties.
Reports & documents complaints when/if received.
Demonstrates excellent communication skills.
Any other job duties or tasks as assigned.
Active RN license in good standing mandatory
Minimum two years? experience as a work comp case manager.
Excellent computer skills, including database knowledge.
Excellent customer service skills and phone etiquette.
Excellent organizational skills and attention to detail.
Communication - Must be able to express ideas clearly, concisely, and logically. Must make effective and persuasive arguments when discussing medical care issues.
Initiative ? proactive in resolving problems, reporting discrepancies, suggesting new ideas and seeking process improvements.
Judgment - use of good clinical judgment as it relates to medical treatment in case management.
Flexibility ? must be willing to adjust as the industry or job requirements change.
Teamwork ? must work well in a team and help foster a cooperative environment.
Represent a positive, professional image of the company.
Certified Case Manager preferred (CCM)
Experience auditing medical charts against itemized medical bills.
Bilingual ? Proficient verbal and written communication skills in a foreign language (including but not limited to Spanish, Portuguese, Mandarin, and/or French) a plus but not required
Comprehensive benefits package including Medical/RX/Dental/Vision insurance
401k Plan with company match
On site fitness center
Casual dress environment
Tuition reimbursement plan
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