Medical Case Manager

6 days ago

Norwalk, Connecticut, United States USI Insurance Services Full time
Job Summary

We are seeking a highly skilled Medical Case Manager to join our team at USI Insurance Services. As a Medical Case Manager, you will be responsible for managing medical aspects of workers compensation and disability claims for Third Party Administration (TPA) accounts.

Key Responsibilities
  • Case Management: Manage activities of workers compensation and disability claims, case management, and utilization review according to established policies and procedures and applicable legal and regulatory guidelines.
  • Managed Care Activities: Manage ongoing managed care activities, including case management of medical aspects of workers compensation and disability claims for TPA accounts by coordinating with patients, physicians, other healthcare providers, and employers to facilitate positive patient outcomes, timely return to work if applicable, and efficient claims resolution.
  • Communication and Collaboration: Present case management and utilization review information and overviews to prospects and clients as needed. Assist adjusters with complex medical aspects as necessary. Resolve escalated issues and problems by conferring with staff, management, other internal departments, outside contacts, and clients as necessary.
  • Customer Service: Assess internal and external customer needs and manage activities to ensure services are delivered in the most efficient way possible.
  • Quality Assurance: Review and evaluate medical claim activities on a regular basis, ensuring that established policies and procedures are being followed.
  • Departmental Communication: Ensure ongoing department communications with sales, claims, and management as well as other Company departments to exchange account and other information.
  • Industry Knowledge: Maintain knowledge of current developments in the managed care industry, including regulatory issues and guidelines changes.
  • Special Projects: Participate in special projects and perform additional duties as required.
Requirements
  • Education: 4-year nursing degree or the equivalent combination of education and work experience required. Masters degree in business, healthcare, or other related field preferred.
  • Experience: A 5 to 10 years workers' compensation and disability case management experience required.
  • Skills and Abilities: Excellent understanding of managed care industry practices, including medical case management, utilization review, and related legal and regulatory guidelines. Strong clinical background in orthopedics, neurology, or rehabilitation. Highly organized, with ability to manage work involving large client volume. Project management skills. Strong understanding of managed care technology applications. Excellent communication skills, both verbal and written. CCM, CRS, or CDMS certification required. State licensing in jurisdiction handled. Superior written and oral communication skills. Ability to work well in a team environment. Must have strong analytical thinking and problem-solving skills. Strong organizational skills required.

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