This position is responsible for providing case management services for employees that have have been injured at work. The goal is to promote quality, cost-effective outcomes while assisting individuals with reaching pre-injury levels of functioning and/or maximum medical improvement. Duties will include coordinating medical care, establishing return to work plans, and providing counseling.
This individual is responsible for telephonic case management of work related injuries which includes assessment, planning, coordination, implementation and evaluation of. injured/disabled individuals.
In this role, you will be responsible for supporting and driving quality standards through meeting all ESRD regulatory requirements and the practice of Quality Assessment and Improvement (QAI), including use of QAI tools.
Performs utilization and case management for Health Plan members. Responsibilities include utilization management and review of pre-authorization requests and inpatient admissions to determine the appropriateness of the identified services.
The Case Manager works with insurance carriers, medical care providers, attorneys, employers and employees, and closely monitors the progress of the injured worker and reports results back to the employer and insurance carrier.