Medical Case Manager – Telephonic Case Management

Job not on LinkedIn

🔥 12 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $85k - $92k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

🤝 B2B

⚕️ Healthcare Insurance

B2B • Healthcare Insurance

TRISTAR Insurance Group is a national third-party administrator (TPA) that provides insurance administration and risk management services to employers, insurers and public entities. Its solutions include property & casualty, workers' compensation, general and auto liability, managed care (bill review, case management, utilization review, nurse triage, pharmacy benefit management), absence and disability management, employee group benefits administration, and risk control and workplace safety services. TRISTAR emphasizes collaborative, technology-enabled and tailored services to transform risk into opportunity for its clients.

📋 Description

• Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care. • Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan. • Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner. • Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services. • Assessment of medical records for appropriateness of treatment and level of care being provided. • Referral to the Medical Director if appropriate within the established timeframes. • Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians. • Maintains contact and communicates updated activity with all parties involved with the case. • Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes. • Negotiate treatment plan with treating physician.

🎯 Requirements

• Diploma, Associate or Bachelor’s degree in Nursing, Master’s level (or higher) in a Nursing, Health or Human Services field or equivalent related experience preferred. • Current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case Manager (CCM) license required. • CCM, CMCN, CPHUR, CPDM, COHN or CDMS certification preferred. • Three or more years of diverse clinical experience in acute care. • Two or more years of medical case management or managed care experience, Worker’s Compensation background preferred. • Knowledge of utilization management, quality improvement, discharge planning, and or cost management. • Ability to solve practical problems and deal with a variety of variables. • Proficient with Microsoft Office applications including Word, Excel, and PowerPoint.

🏖️ Benefits

• Medical, Dental, Vision Insurance. • Life and Disability Insurance. • 401(k) Plan • Paid Holidays • Paid Time Off. • Referral bonus.