Case Manager Jobs

About The Position

Requirements

• Must have thorough knowledge of both CPT and ICD coding
• Ability to interface with claims staff, attorneys, physicians and their representatives, as well as advisors/clients and coworkers
• Effective organization skills in a high-volume, fast-paced environment
• Strong time management skills with the ability to meet designated deadlines
• Excellent written and verbal communication skills
• Ability to work both independently and within a team environment
• Strong interpersonal skills
• Ability to utilize Microsoft Office including Excel spreadsheets
• Graduate of accredited school of nursing with an associate’s degree, Bachelor of Science degree or Bachelor of Science in Nursing
• Current Nursing licensure in the state of operation required; RN is required unless local state regulations permit LVN/LPN
• 4 or more years of recent clinical experience

Nice To Haves

• Knowledge of the workers’ compensation claims process preferred
• Knowledge of outpatient utilization review preferred
• Prospective, concurrent, and retrospective utilization review experience preferred
• Experience in the clinical areas of OR, ICU, CCU, ER and/or orthopedics preferred

Responsibilities

• Identifies the necessity of the review process and communicates issues of concern to the appropriate claims staff/customer
• Collects data and analyzes information to make decisions regarding certification or denial of treatment
• Documents all work in the appropriate manner
• Promotes utilization review services with stakeholders
• Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
• Additional duties as assigned

Benefits

• Medical (HDHP) w/Pharmacy
• Dental
• Vision
• Long Term Disability
• Health Savings Account
• Flexible Spending Account Options
• Life Insurance
• Accident Insurance
• Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K
• ROTH 401K
• paid time off