Telephonic Case Manager - Treatment Compliance

Enlyte

79d • $54,000 - $85,000

About The Position

Join our dedicated team ensuring appropriate treatment and billing integrity for worker's compensation claims. As a Telephonic Case Manager, with a specific focus on treatment plan compliance, you will work within a specialized federal framework to ensure treatment plan adherence and appropriate billing practices. In this role, you will interface with treating physicians/providers to request, document, and monitor treatment plans while verifying that all services billed align with the approved plan of care.

Requirements

• Education: Associates Degree or Bachelor’s Degree in Nursing or related field
• Experience: 2+ years clinical practice preferred. Workers’ compensation-related experience preferred
• Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills
• Certifications, Licenses, Registrations: Active Registered Nurse (RN) license required. Must be in good standing
• Internet: Must have reliable internet

Responsibilities

• Utilize national treatment guidelines to document, track, and evaluate treatment plans for injured/disabled individuals
• Request and secure detailed treatment plans from medical providers, serving as the primary point of accountability for plan documentation
• Hold physicians and providers accountable to the established treatment plans, monitoring for deviations and addressing them promptly
• Verify that all billed services directly correspond to the approved treatment plan, flagging discrepancies for review
• Demonstrate knowledge of regulatory requirements and compliance standards within federal guidelines
• Use knowledge of types of injury, medications, treatment options, and treatment alternatives to effectively evaluate proposed treatment plans
• Review documentation to assess whether treatments align with diagnosed conditions and national guidelines
• Communicate with providers regarding treatment plan adjustments and billing discrepancies
• Document all interactions within the federal system to maintain comprehensive records
• Independently manage workload, including prioritizing cases and deciding how best to manage compliance effectively
• Complete other duties as assigned, such as preparing compliance reports and assisting in training/orientation of new staff as requested

Benefits

• Medical, Dental, Vision
• Health Savings Accounts / Flexible Spending Accounts
• Life and AD&D Insurance
• 401(k)
• Tuition Reimbursement
• An array of resources that encourage a lifetime of healthier living

What This Job Offers

• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 1,001-5,000 employees