Medical Case Manager – Telephonic Case Management

Job not on LinkedIn

🔥 12 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $85k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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TRISTAR Insurance Group

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1987

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

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, including assessing, planning, implementing, and coordinating care • Conduct and document initial assessments with injured workers, employers, and providers • Maintain regular contact with all parties to facilitate communication and formulate clinical case plans • Coordinate contact with providers, claimants, return-to-work contacts, and claims examiners • Review case records and reports, collect and analyze data, evaluate medical status, and define needs and problems • Assess medical records for appropriateness of treatment and level of care • Refer cases to the Medical Director when appropriate within established timeframes • Facilitate timely return-to-work dates with claimants, employers, and physicians • Monitor medical appointments telephonically to address return-to-work, treatment plans, potential issues, and treatment outcomes • Negotiate treatment plans with treating physicians • Meet administrative requirements, including productivity, time management, quality assurance, billing, and documentation standards • Maintain confidentiality and comply with laws and regulations pertaining to HIPAA and PHI • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in nursing, or Master's level (or higher) in a Nursing, Health or Human Services field, or equivalent related experience preferred • Current, unrestricted RN license required • CCM, CPDM, COHN or CDMS certification preferred • Three or more years of diverse clinical experience caring for acutely ill patients with multiple disease conditions • Three or more years of Managed Care and/or Workers' Compensation experience • Knowledge of utilization management, quality improvement, discharge planning, and cost management • Background in state workers' compensation law and practices desirable • Planning, organizing, conflict resolution, and negotiating skills • Excellent interpersonal and organizational skills • Proficiency with Microsoft Office applications including Word, Excel, and PowerPoint • Bilingual a plus • Preferred multi-state experience, including California • Professional attire adhering to the Company Dress Code

🏖️ Benefits

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