Telephonic Case Manager

Telephonic Case Manager - RN (remote, professional/business, non-clinical, must reside in Orlando or surrounding areas)
Feel the Value of Excellence by providing quality medical case management for injured workers, coordinating appropriate care, making recommendations, and professionally communicating with insurance carriers, healthcare providers, ancillary vendors, employers, and attorneys. Make a difference by driving to and attending medical appointments in-person. Complete prompt and thorough documentation and qualify for bonus compensation. Enjoy inserting your own style into the work you do and benefiting from more flexibility at work. This position offers the privilege to impact your earnings and the opportunity to adjust your schedule. Do you have a strong work ethic and high integrity? Then this very rewarding and autonomous role might just be the right fit

COMPENSATION RANGE: $88,000.00 to $140,000.00 annually

GENERAL SUMMARY:

Provide telephonic case management services (within the worker’s compensation industry) by utilizing professional judgment and discretion, applying professional processes, and by using professional expertise to guide complex decision making in alignment with ISYS, customer, and Case Management Society of America (CMSA) expectations.

Facilitate appropriate qualitative and timely medical care for injured workers by implementing prudent case management strategies, making appropriate recommendations to advance case progression, demonstrating proactive communication, and appropriate coordination with all parties to enable optimal recovery outcomes, including return to work determination, file progression towards Permanent and Stationary designation, and cost containment for the customer.

Facilitate timely claim resolution through proactive and professional communications, conducting case specific research, information analysis and providing appropriate advice, direction, and action plans to implement treatment and optimize realistic outcomes. This position differs from Case Manager, as primary case management duties are carried out telephonically with minimal field-based case management activity.

ESSENTIAL JOB FUNCTIONS:

• Telephonic management of cases as assigned by ISYS, including “rush”/same day referrals from ISYS’ customers and attendance at medical appointments scheduled during the hours of the facilities providing treatment.

• Autonomous management of assigned caseload, including coordination of weekly and daily work activities and schedule, ensuring optimal time management and professional prioritization of all activities.

• Providing virtual case management services via videoconferences, teleconferences, and telephonic communications following the CMSA guidelines and ISYS protocols and procedures.

• Enthusiastically and professionally coordinate, facilitate, conduct, and complete virtual attendance at telemedicine appointments, with physicians, other medical professionals and ancillary providers in order to facilitate treatment recommendations in a timely manner.

• Initiate and conduct professional discussions with medical providers regarding diagnosis, treatment, and prognosis.

• Apply the case management process, education, and experience to facilitate appropriate and timely treatment and recovery of the injured worker with the goal of maximal recovery and maximal return to work.

• Provide proactive and timely communication, and coordinate collaboration with all parties involved in each case, by phone, and/or in writing.

• Support the injured worker’s progress towards achieving Maximum Medical Improvement and foster realistic and effective Return to Work opportunities by exploring viable options with all involved parties.

• Influence and collaborate with physicians by providing professional case management opinions and recommendations in order to proactively move cases towards Maximum Medical Improvement and provide cost containment for customers.

• Make recommendations to Claims Professionals/customers in order to ensure the best interests of the injured worker and claims progression, and ensuring the customer is informed of various potential outcomes and potential costs.

• Provide timely written and verbal communication of the employee’s medical status and treatment plan to the Claims Professional and other parties, as necessary, appropriate, and authorized.

• Create effective action plans for customer approval and implement the plan in order to enhance case outcomes and reduce complications, evaluate the success or failure of such plans, and modify plans as necessary to achieve effective and qualitative outcomes.

• Consider customer cost containment in all scenarios and recomme