Medical Case Manager Job Description
Medical case manager
provides telephonic case management and coordinate the delivery of medical care for workers' compensation claims to insure Publix associates are receiving high quality, appropriate, and cost efficient medical care.
Medical Case Manager Duties & Responsibilities
To write an effective medical case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included medical case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Provide individualized medical case management services in ongoing consultation and collaboration with a multidisciplinary staff
Assist with performing activities relating to quality improvement efforts and quality assurance reports
Perform case management functions following the clinical guidelines for case management including, but not limited, to maintaining a tracking system for all test results
Perform QARR related tasks including chart audits, monitoring and tracking QARR results
Participate in Patient Centered Medical Home (PCMH) initiatives
Participate in referral and outreach efforts and events
Assist in ensuring patient-centered communication linkages among the center's direct service providers
Document case management activities in the health center's record according to policy
Assist with outreach efforts relevant to medical case management goals
Manage referrals both internal and external as required
Medical Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Medical Case Manager
List any licenses or certifications required by the position: CCM, CRRN, COHN, CDMS, URAC, CEU, CIRS, CPR
Education for Medical Case Manager
Typically a job would require a certain level of education.
Employers hiring for the medical case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Social Work, Health, Associates, Human Services, Education, Management, Medical, Spanish, Pharmacy
Skills for Medical Case Manager
Desired skills for medical case manager include:
Case management practices and ability to quickly learn and apply workers compensation/case management products and services
Microsoft Office products and Lotus Notes
Available community resources available to assist members
Available resources for addressing identified member needs and to facilitate proactive and efficient provision of services
Medical Terminology and Medical Diagnostic Categories/Disease States
Periods of disability
Treatment needed
Workers’ compensation and federal laws that impact the delivery of health care and return to work
Nature and extent of injuries
Both behavior intervention plans and skill development goals
Desired experience for medical case manager includes:
Develops, manages and directs staff to ensure the delivery of department specific products and services
Manages performance management program including establishing and communicating objectives, providing on-going coaching, and conducting performance reviews
Ensures appropriate compliance with all legislation, corporate policies, and programs
Recruit and hire program staff assigned
Coordinate and support medical and mental health providers on implementation of patients’ comprehensive treatment plan
Ensure necessary referral for social, medical and mental health services are made
Medical Case Manager Examples
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Medical Case Manager Job Description
Job Description Example
Our growing company is looking to fill the role of medical case manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical case manager
- Ensure all required data was collected and reported in electronic medical record in timely manner for quality of care
- Identify and recruit patients to facilitate early access to treatment
- Work as a part of Clinic multi-disciplinary team and Support Services Department for continuous quality improvement (CQI) activities
- Receive case assignments in the appropriate absence management system
- Notify employee of eligibility to take FMLA and/or other statutory leaves
- Make additional contacts to obtain information (doctor)
- Generate appropriate correspondence to be sent to the employee
- Process re-certifications required for continuing FMLA
- Review FML cases and utilization
- Provide proactive primary case management to the company’s Primary Care Clinic including intake, comprehensive assessment/reassessment, and individualized care plan development to ensure access to medical care and other services including communication with primary care provider (PCP) at regular intervals to ensure patients have positive health outcomes
Qualifications for medical case manager
- Coordinate and link patients with additional services, specialty care, entitlements, mental health and substance use treatment, community follow-up case management, AIDS Drug Assistance Program (ADAP), as needed and report outcome to PCP and multidisciplinary care team
- Obtain prior-authorization for pharmacy or medical services that are not covered by patient’s health insurance plan
- Maintain accurate reporting in both electronic and paper record to ensure and meet all documentation and data reporting requirements of the agency
- Identify and recruit Asians and Pacific Islanders who are living with HIV/AIDS to facilitate early access to treatment and social services
- Work as a part of Clinic multi-disciplinary team and Client services Department for continuous quality improvement (CQI) activities
- Ability to perform basic math, compute, calculate, percent and to interpret bar graphs
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Medical Case Manager Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of medical case manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical case manager
- Interacts with DIDD providers TennCare providers
- Makes appropriate use of Forte, inc. physicians for adjuster support, peer-to-peer consultation and as professional resources
- Participates in the collection of outcome information and Forte’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction
- Some field case management will be required within 100 mile radius of Palm Beach County
- Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention
- May perform job site evaluations/summaries to facilitate case management process
- Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services
- May obtain records from the branch claims office
- May review files for claims adjusters and supervisors for appropriate referral for case management services
- May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases
Qualifications for medical case manager
- Able to effectively summarize complex and at times, voluminous medical records
- Licensed Registered Nurse (LRN) required
- Three (3) years in telephonic case management role preferred
- 3-5 years minimum of clinical experience is required
- Experienced in provision of excellent customer service
- Strong technology skills are required
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Medical Case Manager Job Description
Job Description Example
Our company is searching for experienced candidates for the position of medical case manager. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for medical case manager
- Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer
- May recommend and facilitate completion of peer reviews and IME’s by obtaining and delivering medical records and diagnostic films notifying patients
- Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning)
- May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases
- Facilitates a timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician and employer
- Works telephonically with employees, employers, providers and claim handlers to coordinate and assure proper delivery and oversight of medical and disability services
- Assists the injured employee by providing medical and disability education and coordinates on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations
- Negotiates and assists the employers with the development of transitional sedentary or modified job duties based on the injured patients’ functional capacity to accommodate employees to a safe and timely return-to-work
- Evaluates and coordinates medical and rehabilitative services using cost containment strategies
- Develops and promotes a positive and cooperative partnership with the customer
Qualifications for medical case manager
- Experienced and very comfortable working with WORD documents, EXCEL and Outlook
- Minimum of five (5) years health care experience with at least three (3) years of clinical experience
- Assessment – The case manager will collect information about a person’s situation and functioning to identify individual needs in order to identify members risk for high cost medical care and develop an appropriate case management plan that will address those needs
- At least 3 years experience in medical case / injury / return-to-work management
- Registered Nurse / Physiotherapist / Occupational Therapist / Occupational Nurse / Medical Practitioner / Certified Return-to-work Coordinator are welcome to apply
- Candidates with less qualification or experience will be considered as Assistant Medical Case Manager
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Medical Case Manager Job Description
Job Description Example
Our company is growing rapidly and is looking for a medical case manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for medical case manager
- Presents a courteous, helpful, professional manner to all callers
- Notifies management when it appears that communications will not be completed within specific time frames or for other case issues that require supervisory advice/decisions
- Adheres to Customer Special Account Instructions to include documentation requirements and turnaround times
- Participates in the precepting of new employees, as assigned
- Gathers relevant data and information by conducting clinical interviews with the injured employee, the provider(s), and the employer
- Assesses and identifies barriers to recovery
- Plans a proactive course of action to address issues presented and enhances the injured employee’s short and long term outcomes
- Performs pre-certification process for prescribed treatment
- Facilitates and promotes timely and effective communication between all parties involved
- Works address treatment alternatives
Qualifications for medical case manager
- Proficiency in both spoken and written English and at least one Asian language
- Experience in liability investigation / negotiation / mediation would be an advantage
- Reliable and a team player
- Assess resource utilization and cost management
- Routinely assess client’s status and progress
- The case manager will perform the six essential activities of case management in the appropriate manner as reflected by the case type
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Medical Case Manager Job Description
Job Description Example
Our company is looking for a medical case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for medical case manager
- Monitors and evaluates case management outcomes and identifies case management approaches
- Acts as a strong problem solver utilizing analytical ability and demonstrating this competency through communication, organization and interpersonal skills
- Obtaining and maintaining applicable designations are encouraged
- Assess essential functions of job, both physical and mental, to facilitate a safe return to work and return to best medical status
- Performs medical or behavioral review/authorization process
- Ensures coverage for appropriate services within benefit and medical necessity guidelines
- Utilizes allocated resources to back up review determinations
- Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals)
- Participates in data collection/input into system for clinical information flow and proper claims adjudication
- Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal)
Qualifications for medical case manager
- Coordination – The case manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the case management plan when appropriate and reflected by the case type
- Monitoring – The case manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the case management plan when appropriate and reflected by the case type
- Evaluation – At appropriate and repeated intervals, the case manager will determine the plan’s effectiveness in reaching desired outcomes and goals
- Fluent in English and at least one other language (French, German, Italian, Spanish, Portuguese, Russian)
- Minimum of 5 years working experience in EMS, Critical Care, Emergency Department
- Personal expertise and knowledge in emergency/critical care, aero medical transport services, and knowledge of flight physiology is a plus