Telecommute – US National
Medical Case Manager Group Benefit Claims-2000705
As Medical Case Managers, we seek to improve on our patient’s abilities! This position is part of a dynamic, fast-paced team of experienced Medical Case Managers located remotely across the United States. The ideal candidate for the Medical Case Manager role will oversee Short Term and Long Term disability case files. On average, a Medical
Case Manager shall handle 65-75 cases with a moderate degree of complexity and acuity of a medical condition. This individual will have the opportunity to collaborate with claims staff, the injured worker, an employer, and other healthcare professionals to promote quality medical care with a focus on returning our patients back to work. Our goal is to achieve optimum, cost-effective medical and vocational outcomes.
The successful hire will be responsible for the review of Long-Term Disability (LTD) and Short-term Disability claims with complex medical conditions referred for medical assessment; clarification of limitations/ restrictions; and/or case management.
Work closely with the STD/LTD Claims Team to identifying appropriate claim referrals and effectively assessing claims to ensure they reach the appropriate claim outcome.
Collaborate with Rehabilitation Case Managers; Ability Analysts; Employees, Policyholders, Healthcare Providers, and Vendors to facilitate and coordinate case management strategies to facilitate a potential Return to Work.
Clearly document and track efforts and outcomes.
Periodically participate and facilitate training programs and/or presentations
At least 3 years of current clinical experience in acute care, orthopedic, rehabilitation, industrial medical settings, or current experience as a Disability Case Manager
Registered Nurse (RN) preferred, however, we will consider candidates with LPN and Disability/Case Management experience.
CCM or comparable industry certification
Clinical ability to assess LTD Claims with complex medical histories which may include claimants with subjective diagnoses, co-morbid conditions, etc.
Strong written/ verbal communication skills; computers and Microsoft Office programs.
Ability to explain complex medical conditions and the ability to communicate with attending physicians to identify current limitations/restrictions as it relates to the workplace.
Accurate clinical assessment and analytical skills, ability to make sound judgments and to accurately document activities, and the desire to learn about the insurance business.
Must keep current in the area of expertise and acquire CEU’s as necessary to maintain certification.
Negotiation skills, problem-solving, plan development competencies are essential
Organizational and Change Management skills, accountability in meeting deadlines, and being a team player are also Essential
WHAT ELSE CAN YOU TELL ME?
This is a work from home opportunity (remote).
Equal Opportunity Employer/Females/Minorities/Veterans/Disability/Sexual Orientation/Gender Identity or Expression
Internet Connectivity Requirement/Remote Positions: For 100% remote positions, we require that (1) you have high-speed broadband cable internet service with minimum upload/download speeds of 3Mbps/30Mbps and (2) your Internet provider supplied device is to be hardwired to the Hartford issued router and/or computer. To confirm whether your Internet system has sufficient speeds, please visit http://www.speedtest.net from your pers…
Insurance , Medical & Health , Case Management