Provides case management services, consulting with appropriate party to provide timely updates and obtain medical documentation for treatment and return-to-work purposes.
ESSENTIAL JOB RESPONSIBILITIES:
- Provide case management through a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an injured worker’s health needs using communication and other available resources to promote quality cost-effective outcomes.
- Consult with the injured worker, their family, service providers, employer, the Bureau of Workers’ Compensation, and other parties to the injury claim to provide timely updates and obtain necessary medical documentation for treatment authorization and return-to-work needs.
- Assess and process treatment requests and obtain timely estimates for release or actual return-to-work.
- Identify opportunities; determine likelihood for success; and recommend strategies for injury claims that may benefit from vocational rehabilitation services.
- Complete all data entry requirements for managed care activities.
- Participate in, and assist with maintaining, quality management activities as appropriate.
- Uphold all BWC, FGMCS and URAC standards as defined in the organization’s policies and procedures.
- Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline
- Must have at least one of the following case manager certifications within 4 years of hire: Certified Rehabilitation Counselor (CRC), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Registered Nurse (CRRN), Certified Occupational Health Nurse (COHN), or Certified Case Manager (CCM); or a Bachelor’s degree (or higher) in health or human services or related field; or possess a Registered Nurse (RN) license
- Two years full-time equivalent of direct clinical care to the consumer, preferably in: critical or emergent care; home health; occupational medicine; orthopedics; neurology; or sports medicine.
- Reviewing, understanding and practicing within the scope of licensure
- Maintenance of professional development, continuing education and licensure
- Excellent analytical, communication, computer, interpersonal, and problem solving skills
- Excellent time management and organizational skills
- Ability to work both individually and in a team environment
- Customer service oriented-internal staff and external clients
- Knowledge and proficiency with Ohio Workers’ Compensation and managed care concepts
- Knowledge of state and federal regulations (Ohio Workers’ Compensation, HIPAA, ADA, FMLA)
- Microsoft Office products
- PC-based software programs and automated database management systems
- Automated database management systems
- CPT codes (Current Procedural Terminology)
- ICD-9-CM codes ( International Classification of Diseases)
- Official Disability Guidelines
- Miller criteria
- MCO policy and procedures