Medical Field Case Manager
About The Position
This is an IN PERSON Case Manager role in the field. A wide variety of creativity and latitude is expected. The FCM carries an active caseload, represents IMO in a professional manner at all times to our clients and assigned injured employees and attends file reviews as requested. The successful candidate will be familiar with Texas Workers' Compensation as well as ODG (Official Disability Guidelines) and will collaborate with physicians and the multidisciplinary team including adjusters, medical care providers, and employers to facilitate the plan of care and assist in identification and concurrent resolution of variances. Acknowledgement of referral receipts to adjuster will occur within 24 hours of receipt - for referrals received after hours or on Fridays, contact will occur within 24 hours of the next business day. Three-point contacts, with the injured employee, the employer, and the medical provider(s), will be made within 48 hours of receipt of referral. For referrals received after hours or on Fridays, contact will occur within 48 hours of the next business day The Field Case Manager will provide the initial report to the IMO office within two (2) weeks of referral. This report will include action plan with projected length of time on file, projected RTW timeframe, updated medical information, and projected medical costs-based industry standard guidelines for diagnosis. The Case Manager will update adjusters within 24 hours of each visit activity by utilizing the "IMO Email Update" report. FCM acts as a liaison for the injured employee and communicates with the client while maintaining neutral position between all interested parties. They provide assistance to injured employees as needed with selection of treating physician from the Network provider list as well as assist injured worker and physicians with specialist referrals and ensure utilization of providers within the Network. It is important to maintain communication with employer, adjuster as needed for coordination of RTW (Return to Work) efforts and initiate required forms and letters of communication as indicated throughout the case management process. They utilize clinical/nursing skills to coordinate the individual's treatment program while maximizing cost containment and provide documentation in the IMO SmartCat Software, updating medical notes medical status and RTW Status. Communication with claim examiners is critical, and it may be necessary to participate with file reviews to ensure that disputes or other non-medical issues are addressed accordingly
Requirements
- Must reside in the San Antonio, TX area
- Bilingual in Spanish English required
- Must have certification in case management, i.e., CCM, CRN, CDMS, CRC, COHN
- 1099 Contractor
- familiar with Texas Workers' Compensation as well as ODG (Official Disability Guidelines)
Nice To Haves
- RN preferred
- Bachelors Degree in nursing or related field preferred
