York Risk Services Group
US National – 100% Remote Work
Manager Case Management
Remote – U.S.
At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. That’s why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.
Nursing, case management, or other health care profession experience of at least five to ten years and demonstrated expertise with quality assurance and compliance standards and process, rehabilitation, insurance, managed care, workers compensation and outcomes.
Prefer previous experience in supervisory and management position.
Minimum of two years’ experience in workers’ compensation case management
Demonstrated experience and competency in working with individuals and groups.
RN, BSN, CCM preferred, other undergraduate degrees allowing a CCM will be considered.
Maintain active nursing license in home state; Willingness to obtain nursing licenses in other states, as requested
Essential / Major Duties
Review and oversee case content, documentation, and adherence to special handling instructions and billing guidelines.
Ensure productivity, efficiency, and effectiveness through pro-active case management.
Demonstrate successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
Manage work and performance of contract staff, oversee work produced and provide training and support as needed.
Knowledge, Skills, and Abilities
Knowledge of Case Management Code of Conduct
Knowledge of 1099 employment of guidelines
Knowledge of state statutes and laws regarding workers compensation.
Knowledge of medical case management program.
Knowledge of industry standard case management billing practices
Knowledge of patient rights and commitment to patient advocacy.
Effective educator skills.
Excellent written and oral communication skills.
Ability to understand and interface with claim systems.
Intermediate proficiency with Google Suite.
Word processing and data entry skills.
Demonstrate ability to identify problems and implement a plan of improvement within the constraints of 1099 laws and guidelines.
Job Duties and Responsibilities
Review vendor files for appropriate documentation and proactive case management
Monitor documentation and billing of file activity to ensure adherence to industry quality and billing standards.
Provide ongoing training as identified through file reviews or new account implementation.
Assist with Carelink Systems training and education after new contract agreement initiated
Maintain a complaints log noting any action taken
Assist Senior Manager in Special Projects as requested
KEY PERFORMANCE INDICATORS
Customer Service Satisfaction
Case Management Industry Standards Maintained by 1099 Staff
Insurance , Medical & Health , Case Management