Medical Case Manager

The case manager provides medical and vocational assistance and coordination services to assist injured workers in reaching maximum medical improvement and return to work. The case manager facilitates communication between all parties including the injured worker, the adjuster, the employer, treating physician(s) and ancillary providers to assist the injured worker in obtaining prompt and appropriate medical treatment. The case manager assesses rehabilitation needs and makes appropriate recommendations. The ultimate goal is for the injured worker to recover and return to work as soon as is medically appropriate. The case manager facilitates any temporary or permanent job modifications necessary to allow the injured worker to return to work within the applicable physical restrictions assigned by the doctor. The exact role the case manager plays will vary with the injury management model used by each customer. The responsibilities on each case may vary.

Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services
Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations); Schedules appointments to avoid delays in treatment by primary care physicians, specialists or ancillary services
Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved
Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports
Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed
Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim; Work with the treating physician to update any conditions as medical treatment progresses
Assesses the injured worker and his/her support system and family; Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment; The job must be consistent with any physical restrictions assigned by the treating doctor; Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force
Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan
Maintains constant contact with the adjuster assigned to the file through telephone calls, EMAIL and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the telephonic case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer
Makes appropriate use of Forte, Inc. physicians for adjuster support, peer-to-peer consultation and as professional resources; Makes appropriate use of Forte, Inc. clinical and information systems staff to deliver exceptional service to direct and indirect customers
Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties
Acts as an advocate for the injured worker with all parties while maintaining the injured worker's privacy and safety; Adheres to Forte's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
Participates in the collection of outcome information and Forte's Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers' compensation and federal laws that impact the delivery of health care and return to work
Become proficient in the software used in the department
Contribute to the success of the company and its posture toward customer service by a positive and professional attitude and by understanding and responding to the needs of our direct and indirect customers; Follows ethical, legal, and regulatory standards
Performs other duties as assigned

York Risk Services Group, Inc. is an equal opportunity/affirmative action employer

Required Skills
SKILLS/ABILITIES:
The ability to work effectively with minimal direct supervision
The ability to plan and use time effectively
The ability to work as a member of the Forte, Inc. team
Must be computer literate
Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement
Due to the nature of the position, sitting in a sustained position for prolonged periods is necessary
Vision must be adequate to view the computer screen
Must be able to operate a vehicle and to travel on a regular basis, which may include occasional air travel and overnight stays
Must have the ability and willingness to travel for task and/or field case management visits if within assigned geographic areas
Must possess a valid driver's license
Must provide proof of insurance
Required Experience
EDUCATION:
BS / BA or Equivalent Work Experience
Must currently have nursing license, bachelor and/or masters' degree in a related field
CPM required based on state guidelines.
CCM, CIRS, or CRRN is preferred but not required

Experience:
Two or more year's workers compensation case management experience

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