See more Collapse

Case Management Technician

2 months ago

Portland, United States Kaiser Permanente Full time

Description: Job Summary:To analyze and process internal, external, transfer requests and provide and obtain authorization or denial by working with Occupational Health (OH) guidelines, the OH Chief Physician and the insurer. To pre-certify MCO surgery requests and provide and obtain authorization or denial by working with OH guidelines, the OH Chief Physician and the insurer. To document accurately to comply with billing requirements. To provide communication to the insurer, physician, vendors and patients, and facilitate scheduling. To provide support to the Nurse Case Managers.Essential Responsibilities:Facilitates compliance with Workers Compensation Division 15 rules by conducting review of medical record for surgical medical necessity based on established protocol/screening criteria. Abstracts and interprets medical documentation as it relates to diagnosis & procedure, and analyzes for decision/action. Problem-solves related issues and makes initial determination to approve or triage the precertification. Provides/ensures high degree of accuracy and attention to detail in precertification review documentation. Coordinates pre-certification review to MCO Medical Director whether referral is based on internal protocols or insurer request. Facilitates MCO Medical Directors review. Monitors for review outcome and disseminates determination. Ensures compliance with Division 15 rules by identifying second surgical opinion cases, facilitates/coordinates with MCO Medical Director and provides review support on a case by case basis. Generates appropriate documents to communicate MCO Medical Directors decision to insurer, injured worker, and surgeon. Prepares documentation for denial/disapproval of procedure, service or device. Assigns length of stay (LOS) for all inpatient admissions. Identifies/triages injured workers to Case Managers and OH Service Center for additional services and/or follow-up.Coordinates and conducts surgery notification and pre-authorization process for the OH Department. Works within defined timeframe with specialty service nursing and doctors to obtain pertinent data required by state and federal regulated agencies. Verifies correct ICD-9, ICD-10 and CPT coding for proper reimbursement. Also obtains pre-authorization for certain other assigned procedures (ex. MRIs). Research and verify claim and membership status, contacting and coordinating appointment between injured worker and non- plan medical provider. Coordinate record gathering, claim information and approve scheduling. Contact MCO Medical Director to arrange second-level review. Contact internal and external customers to obtain or provide information which assists in determining medical necessity and/or surgery authorizations. Work with specialty services nursing, OH nursing, and physicians on daily basis. Identifies areas for administrative review. Identify cases and direct them to area case managers.Coordinate/manage external specialty referrals for: Work Hardening and Conditioning Programs, Pain Program, Brain Injury Rehabilitation Consultation (BIRC), and Physical Capacity Evaluations (PCE) for the OH Department. Works with providers, injured workers, and external vendors to facilitate appointment, approval and record transfer.Coordinates, maintains, updates and distributes external contract specialty vendor lists for department. Maintains contract dataset in claims tracking system.Maintains a monthly precertification log and reports. Monitors precertification process and identifies/implements operational changes which promote efficiency and accuracy. Develops ongoing policies and procedures for precertification program and surgery notification/authorization process including written communication plans, forms, or program letters.Analyze and process referral requests for OH patients to non-plan specialty services. Obtain necessary approval from department Chief, or MCO director including exceptions to department protocols. Verify status of contract provider, verify diagnosis, date of injury, employer/insurer. Notify insurer. Obtain current claim status and insurer information and/or insurer approval if necessary. Verify authorization for service. Coordinate patient care with non-Plan providers. Document in Claims Tracking system/KOJUR. Verify and track external provider treatment plans and extension requests. Provide billing information to the providers as well as assist non plan providers with benefit and contractual information. Assist with denied service issues. Maintain and continuously demonstrate general knowledge of workers compensation rules and regulations for Oregon, Washington and Federal workers compensation benefit systems. Ensure state and federal regulatory and contract compliance. Research and verify claim and membership status, contacting and coordinating appointment between injured worker and non- plan medical provider. Coordinate record gathering, claim information and approve scheduling. Coordinate referrals into the Kaiser systems for injured workers who have received treatment at non plan providers and wish to transfer care to Kaiser OH. Contact injured worker and verify claim information, claim status and eligibility for transfer. Coordinate medical record transfer, communicate approval for scheduling and provide claim and medical record information to Kaiser OH providers for review prior to treatment. Send information to advice nurse for triage and approval by the MCO Director, Chief Physician or designated physician. Obtain authorizations needed to secure payment for assigned procedures. (ex. MRI, ESI, DME). Maintain KOJUR database of contracted providers and CHP providers for MCO Provider List. Perform administrative case management support to the nurse case managers. Perform other duties as assigned. Basic Qualifications: Experience Minimum two (2) years computer experience with working knowledge of word processing. Per the National Agreement, current KP Coalition employees have this experience requirement waived. Education Associates Degree. License, Certification, Registration Registered Health Information Technician Certificate Additional Requirements:Recent experience with coding of diagnoses and procedures (ICD-9, ICD-10, CPT-4).ICD-9, ICD-10, and CPT coding applications.PAS Length of Stay determination.Working knowledge of medical terminology, basic anatomy and physiology.Experience in working with physicians, demonstrating excellent oral and written communication skills.Knowledge of confidentiality guidelines of medical information and medical records handling.Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications: Excellent verbal and documentation skills.Recent work experience with physicians and administrative team.Excellent organizational skills.Excellent interpersonal and telephone skills as well as using interpretive services. Primary Location: Oregon,Portland,Kaiser Permanente Building Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 04:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: W06SEIULocal 49 Job Level: Individual Contributor Department: Interstate - South Medical Ofc - Occupational Hlth-Clin Nurse - 1008 Pay Range: $27.66 - $30.25 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted. Travel: No At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing. Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest Load More

We have other current jobs related to this field that you can find below

  • Travel Nurse RN

    2 weeks ago

    Portland, ME, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Portland, Maine. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 08/26/2024 Duration: 11 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We are seeking a Case Manager-Registered Nurse...

  • Travel Nurse RN

    2 weeks ago

    Portland, ME, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Portland, Maine. Job Description & Requirements Specialty: Case Management Discipline: RN Start Date: 08/26/2024 Duration: 11 weeks 40 hours per week Shift: 8 hours, days Employment Type: Travel We are seeking a Case Manager-Registered Nurse...

  • Floor Technician

    5 days ago

    Portland, United States Nandail Property Management Full time

    Company Review:Nandail Property Management is a firm specializing in maintaining residential and commercial properties. With a commitment to excellence, we ensure that our clients' properties are well-maintained, safe, and comfortable for tenants.(Website Link: www.nandail.com )Job Details:We are hiring independent maintenance technicians. Once hired,...

  • Case Manager

    2 months ago

    Portland, United States Maine Medical Center Full time

    Summary For a limited time MaineHealth is offering up to $5,000 Sign on bonus for all eligible Case Managers! Eligible candidates are hired (offer accepted) into a Full or Part time Case Manager position. Bonus amount prorated for Part time hires, per diem hires are ineligible. Current MaineHealth member employees are ineligible; former MaineHealth Members...

  • Floor Technician

    1 week ago

    Portland, United States Nandail Property Management Full time

    Job DescriptionJob DescriptionCompany Review:Nandail Property Management is a firm specializing in maintaining residential and commercial properties. With a commitment to excellence, we ensure that our clients’ properties are well-maintained, safe, and comfortable for tenants.(Website Link: www.nandail.com )Job Details:We are hiring independent maintenance...

  • Case Manager

    1 month ago

    Portland, United States Constructing Hope Pre-Apprenticeship Program Full time

    Constructing Hope’s mission is to rebuild the lives of people in our community by encouraging self-sufficiency through skills training and education in the construction industry. We provide no-cost, ten-week construction training programs, placement services, and career advancement support. We serve minorities, people coming from incarceration, and...

  • Case Manager

    1 month ago

    Portland, Oregon, United States Constructing Hope Pre-Apprenticeship Program Full time

    Constructing Hope's mission is to rebuild the lives of people in our community by encouraging self-sufficiency through skills training and education in the construction industry. We provide no-cost, ten-week construction training programs, placement services, and career advancement support. We serve minorities, people coming from incarceration, and...

  • Travel Nurse RN

    2 weeks ago

    Portland, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Hospice for a travel nursing job in Portland, Oregon. Job Description & Requirements Specialty: Hospice Discipline: RN Start Date: 07/08/2024 Duration: 13 weeks 40 hours per week Shift: 8 hours Employment Type: Travel TotalMed Case Management Staffing Job ID . Pay package is based on 8 hour...

  • Travel Nurse RN

    2 days ago

    portland, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Home Health for a travel nursing job in Portland, Oregon.Job Description & RequirementsSpecialty: Home HealthDiscipline: RNStart Date: 09/03/2024Duration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelWe are seeking a Registered Nurse-Home Health for a travel assignment in...

  • Case Manager

    1 month ago

    Portland, United States Encompass Health Full time

    Job DescriptionJob DescriptionHiring for PRN positionsHourly rate starting at $35. 00 / hour weekdaysCase Manager Career OpportunityRecognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you...

  • Case Manager

    4 weeks ago

    Portland, United States Encompass Health Full time

    Job DescriptionJob DescriptionHiring for PRN positionsHourly rate starting at $35. 00 / hour weekdaysCase Manager Career OpportunityRecognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you...

  • Case Manager

    2 weeks ago

    Portland, United States Encompass Health Full time

    Job DescriptionJob DescriptionHiring for PRN positionsHourly rate starting at $35. 00 / hour weekdaysCase Manager Career OpportunityRecognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you...

  • RN Overnight Facility Shifts

    2 weeks ago

    Portland, ME, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Portland, Maine. Specialty: Case Management ~ Shift: 8 hours, days ~ Employment Type: Travel TotalMed Case Management Staffing Job ID #1585669. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free...

  • RN Overnight Facility Shifts

    2 weeks ago

    Portland, ME, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Portland, Maine. Specialty: Case Management ~ Shift: 8 hours, days ~ Employment Type: Travel TotalMed Case Management Staffing Job ID #1585669. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free...

  • Case Manager

    2 weeks ago

    Portland, United States Aureus Group Full time

    Travel RN needed for a 13-week contract. Contact Aureus today for more information and to apply! Position: Case Manager Specialty/Modality: Case Management Licenses/Certifications: State License-RN-Maine Physical Abilities: Up to 20lbs Travel the country while you enhance your clinical skills, perfect your resume, and build your dream career. Some of the...

  • Case Manager

    5 days ago

    Portland, United States Tuerk House Full time

    Position Summary: The Case Manager will be responsible for providing case management services to individuals in the Multnomah County Deflection Center. . This position will work in collaboration with a multidisciplinary team to assess the needs of the individuals participating in deflection services. . The goals of the case manager within the deflection...

  • Case Manager

    4 weeks ago

    South Portland, United States KidsPeace Full time

    The Case Manager is primarily responsible for case coordination, collaboration with inter and intra department systems and provision of information regarding assigned residency caseload. Provide professional management of assigned caseload. Assist as needed with case information access and distribution. Develop working relationships with legal guardians,...

  • Case Manager Paralegal

    1 month ago

    Portland, United States Staffing Solutions, LLC Full time

    Job Description- Litigation Paralegal Staffing Solutions LLC is seeking a litigation paralegal who has seen a case from start to finish; including collaborating on strategy, independently moving cases forward through discovery and investigation, participating in regular team meetings, opportunity to go to trial, and working with brilliant lawyers on...

  • Housing Case Manager

    2 days ago

    Portland, United States JustCompassion Full time

    Job DescriptionJob DescriptionJust Compassion of East Washington County is a Non-Profit community-centered response for addressing the needs of homeless individuals by building relationships and aspiring towards wholeness.Job Title: Housing Case ManagerFull-time: 40 hours/weekPosition Reports To: Programs SupervisorPositions Reporting to the Position:...

  • Case Manager

    7 days ago

    Portland, United States Tuerk House Full time

    Job DescriptionJob DescriptionPosition Summary:The Case Manager will be responsible for providing case management services to individuals in the Multnomah County Deflection Center. . This position will work in collaboration with a multidisciplinary team to assess the needs of the individuals participating in deflection services. . The goals of the case...