Field Case Manager Full-Time Murrieta-Temecula-San Clemente, CA

Charles Taylor•Temecula, CA

3h•$115,000 - $125,000•Hybrid

About The Position

Charles Taylor is a highly successful global provider of professional services to the insurance industry. Guardian Managed Care Solutions, a division of Charles Taylor TPA, is a leading provider of workers’ compensation managed care and cost containment solutions. We are seeking a dynamic Field Case Manager to join our team. This full-time role is based in the Murrieta-Temecula-San Clemente area servicing the Los Angeles and San Diego regions with flexibility to work remotely. The Field Case Manager position is responsible for assessing and analyzing information pertinent to injured employees to evaluate the medical and vocational needs required to facilitate the patient’s rehabilitation in order to promote appropriate and timely return to work. This person will act as a liaison between patient/family, employer, provider(s), healthcare personnel, adjusters, and attorneys involved in workers’ compensation claims.

Requirements

Must hold at least one of the following credentials: CCM, CRRN, CDMS, COHN, CRC
Must hold an unrestricted Registered Nurse license in the state of California
Must maintain all applicable credentials, licensure, and/or certification(s) for case management in the state of California
Must have current, unrestricted driver’s license and be able to provide proof of automobile insurance
Ability to travel day to day within assigned geographic region
Ability to work independently, within a team environment, and deal effectively with multiple tasks simultaneously
Must possess strong professional communication, organizational, and interpersonal skills when interacting verbally and in writing
Strong customer service skills
Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
Computer literacy, daily usage of MS Office Product Suite, i.e., Word, Excel, PowerPoint, Teams
Ability to proofread typed material for grammatical, typographical, or spelling errors
Ability to change and adapt work activities frequently while prioritizing projects
Knowledge of operating standard office equipment i.e., computer, fax, copier, scanner, phone, etc

Nice To Haves

Case management experience at a Third-Party Administrator (TPA), in the medical field, or workers compensation industry
Knowledge or experience with the statutes and rules of Longshore and Harbor Workers' Compensation Act and Jones Act Claims
Knowledge or experience with the statutes and rules of the State of California Workers’ Compensation claims
Spanish speaking, both conversational and medical terminology

Responsibilities

Obtains medical history of the injured employee and a signed medical release form when appropriate for medical care coordination purposes
Requests, obtains, and reviews medical records
Assesses and analyzes an injured employee’s medical and vocational status
Develops a plan of care to facilitate the patient’s appropriate and timely return to work; coordinates with the employer when appropriate
Interviews patients in the physician office, home and/or work site to provide ongoing case management services
Communicates both in-person and telephonically with patients, medical providers, adjusters, attorneys, and vendors
Schedules appointments for implementation and follow-up of treatment plan
Coordinates and monitors progress and completion of vendor referrals, consultations, and therapeutic services for patients
Ensures transportation and translation are available for the injured employee to attend medical appointments when appropriate
Accompanies the injured employees during physician consultations when appropriate
Conferences with specialists concerning course of care and treatment
Ensures all injured employees’ and employers’ concerns are addressed by the physicians
Ensures injured employees understand diagnosis of their injury/illness, and any instructions and recommendations regarding treatment when appropriate
Provides consistent monitoring, contact, support, and education to injured employees to monitor patients’ progress toward desired outcomes, promote compliance, motivation, and address issues as they arise when appropriate
With adjuster approval, coordinate necessary medical and rehabilitative care for injured employees including but not limited to appointments, medications, surgery, therapies, diagnostics, equipment, transportation, translation etc.
Establishes effective rapport with all professions involved in the injured employees’ rehabilitation process to facilitate treatment, optimum care, and successful return to work
Provides comprehensive documentation detailing case management services, the injured employees’ progress with treatment plan, return to work status, maximum medical improvement, and significant events that meets company standards for content and format
When appropriate coordinate return to work issues with the employer, to include job site analysis, ergonomic evaluation, etc. and present to the physician for review
Maintains a working a knowledge of up-to-date medical information including but not limited to medications, procedures, equipment, therapies, treatments, their uses, contraindications, side effects, etc. and provides research information to adjusters to assist with determinations of medical necessity and appropriateness
Applies all laws and regulations relative to the provision of case management and rehabilitation services in the geographic region assigned
Testifies as required to substantiate any relevant case work or documentation
Timely completion of time and expense reporting per company guidelines
Works closely with team of case managers and support staff