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Medical Case Manager

at Integrated Care Management

Posted on 2/3/2012

Location: Charlotte, NC

Job Type: Full Time

Job ID: W606954

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Integrated Care Management (ICM) is a leading disability management firm that services the needs of TPAs, Insurance Companies, Self-Insured firms and the Maritime Industry. ICM offers case management strategies and services (field, on-site, catastrophic and vocational) which can be employed individually or in combination based on the recommendation of our case managers, and in consultation with clients. Integrated Disability Management Services enable employers to integrate Workers’ Compensation, Short-Term Disability and Long-Term Disability into a single actionable and manageable program.

Goal of Position
Provide a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to meet the individual medical and vocational needs through communication with the patient, their medical providers, employer and carrier as needed to promote quality, cost effective outcomes.

Job Description

Provide Case Management services to various individuals, in various settings. These services include insuring communications and coordinating benefits at the onset of injury/illness. The case manager must ensure that patients will receive adequate and timely support to assure quality diagnoses and treatment plans; patient conformance with treatment plans; satisfactory rate of recovery; and, when applicable, return to work on undefined or accommodated duty as therapeutically indicated.
Interject objectivity and information where it may be lacking to maximize efficiency in utilization of available resources.
Promote cooperation between multi-disciplinarians in various settings to work collaboratively during different phases of the person's illness.

Knowledge

Experience communicating with patients, employers, medical professionals, carriers, legal professionals and supervisors.
Ability to form and maintain working relationships with accounts, employers, patients, healthcare professionals, vendors, legal professionals and community medical team.
Working knowledge of SSDI, rehabilitation, disability (STD & LTD), medical and workers’ compensation benefits.
Formal knowledge of medical/rehabilitation case management as manifested by a degree (or acceptable equivalent) as a Rehabilitation Counselor with a CRC and/or Registered Nurse, with a CCM (the following may be considered COHN, CRRN, or CDMS), as well as two years of experience in Field Case Management.
Aptitude to create and follow administration, communication and information systems.
Solid computer literacy.

Problem Solving

Ability to formulate clinical decisions within limits of training and experience.
Ability to involve and correctly use clinical judgments outside limits of training and experience.
Recognize deviations from adequate clinical quality and utilize resources to develop adequate plan for correcting quality.

Job Responsibilities:
Use case management skills to help coordinate the patient’s individual treatment plan while maximizing cost containment.

Educate the patient on his/her injury/disability and the treatment plan established by physician. Explain Physician’s and Therapist’s instructions and answer additional questions the employee may have to facilitate his/her return to work
Work with Physicians and other treatment providers to coordinate an overall treatment plan to ensure cost containment and best medical care while meeting state and other regulatory guidelines.
Research and assess alternative treatment programs such as pain clinics, home healthcare, work hardening as well as coordinate with possible Wellness Program.
Work with employer to identify and develop transitional / modified duty based on medical limitations and employee’s functional abilities as outlined by treating physician. Assist in development of transitional work programs where able in effort to return employee to work per physician direction
Provide expert testimony on litigated cases as needed.
Coordinate patients appointments and arranges services to assist with compliance (i.e. Transportation/Translation) when directed by account
In the event that the employee is unable to return to work with modifications, case manager will coordinate the employee’s vocational rehabilitation to prepare him or her for suitable reentry into the workplace based on independent, professional decision making skills.
Additional duties as assigned

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