Occupational Medicine Coordinator

Kaweah Delta Health Care District•Visalia, CA

5d•Onsite

About The Position

The Occupational Medicine Coordinator is responsible for coordinating and managing workers' compensation cases within the Kaweah Health Medical Clinic–Plaza, which is in part, a workers’ compensation clinic. This position serves as a central resource for patients, providers, employers, insurance carriers, claims adjusters, nurse case managers, and ancillary service providers to ensure timely, efficient, and compliant delivery of care throughout the life of a claim.

Requirements

Minimum of two (2) years of experience in a healthcare setting
Knowledge of California workers' compensation processes, regulations, and terminology.
Understanding of Requests for Authorization (RFAs), Utilization Review (UR), Independent Medical Review (IMR), and return-to-work processes.
Familiarity with workers' compensation reporting requirements, including DFRs, PR-2s, and P&S reports.
Strong understanding of medical terminology and clinical documentation.
Excellent organizational, prioritization, and follow-up skills.
Strong verbal and written communication skills.
Ability to manage multiple cases and competing priorities in a fast-paced environment.
Proficiency in electronic medical records (EMR), Microsoft Office Suite, and database tracking systems.
Ability to maintain confidentiality and exercise sound judgment in handling sensitive information.

Nice To Haves

Medical Assistant (MA) or equivalent healthcare experience
Experience in occupational medicine, case management, utilization management, or referral coordination.

Responsibilities

Coordinate workers' compensation cases from initial evaluation through claim closure.
Serve as the primary liaison between injured employees, providers, employers, insurance carriers, adjusters, attorneys, and other stakeholders.
Monitor treatment progress, address barriers to care, and facilitate timely return-to-work planning.
Communicate treatment plans, work restrictions, and modified duty recommendations.
Manage Requests for Authorization (RFAs) and coordinate referrals for specialty care, therapy, diagnostic testing, imaging, and other services.
Track authorization requests, utilization review (UR) decisions, and referrals to ensure timely treatment.
Coordinate provider review of UR determinations and assist with appeals, peer-to-peer reviews, and Independent Medical Reviews (IMR) when appropriate.
Escalate urgent authorization issues that may impact patient care or compliance.
Assist providers with compliant workers' compensation documentation and reporting.
Prepare, monitor, and submit required reports, including DFRs, PR-2s, Permanent & Stationary reports, and Return-to-Work/Work Status reports.
Ensure documentation is completed accurately and within regulatory timeframes.
Assist patients with claim-related forms and documentation.
Communicate work status updates and restrictions to employers, adjusters, and nurse case managers.
Respond to inquiries and help resolve administrative issues affecting patient care.
Maintain accurate documentation in the electronic medical record and workers' compensation systems.
Ensure compliance with California workers' compensation regulations, MTUS guidelines, clinic policies, and confidentiality requirements.
Monitor performance metrics related to authorizations, referrals, report completion, and claim progression.
Participate in audits, quality improvement, and process improvement initiatives.
Maintain tracking systems for referrals, authorizations, utilization reviews, and required reports.
Prepare reports to support operational performance and leadership decision-making.
Participate in team meetings and perform other duties as assigned.