NATIONAL TPA SEEKS - Bilingual [preferred] WC Case Manager (

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NATIONAL TPA SEEKS - Bilingual [preferred] WC Case Manager (

Postby workcomptpa on Wed Aug 04, 2010 6:01 am

We are a large TPA that is seeking a bilingual [English/Spanish] nurse case manager for our California regional office.The right candidate will be passionate about case management, have at least 5-7 years of experience and reside in the state of CA.

The case manager will perform initial evaluation assessments, determine need for alternative treatment and provide case direction and supervision to field case specialists when on-site intervention is required.

Performs initial evaluation assessment via telephone calls to the injured worker, employer (when requested) and healthcare provider within 2 business days of case management referral.
Evaluates need for alternative treatment.
Facilitates authorized treatment utilizing contracted networks.
Negotiates level of care, intensity and disability duration with providers.
Negotiates and coordinates a prompt return to work with employer.
Adheres to quality assurance standards and department processes.
Provides case direction and supervisor to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
Communicates effectively with claims adjuster, claimant, employer and healthcare provider.
Utilizes national evidence based guidelines and the peer review process
Adheres to the utilization review process
Adheres to state statute concerning time frames for medical care and appointments.
Follows company policies governing the Case management/ workers comp process.
Regular reporting to management on case management status.
Other duties as assigned by ma[*]nagement.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and /or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Ability to analyze and interpret medical data.
High level knowledge of the worker’s compensation industry and claims processes, reporting and regulatory requirements.
Excellent research and investigation skills.
Ability to clearly express and synthesize case facts, decisions and rationale.
Excellent written and verbal communication skills.
Excellent interpersonal skills with a diverse group of contacts.
Maintains confidentiality as well as a high degree of professional integrity.
Ability to provide a high level of customer service while working in a fast-paced environment.
Demonstrated attention to detail with excellent organizational and prioritization skills.
Ability to work well within a team environment and facilitate the team concept.
Ability to understand and work within the claims environment.

Nursing graduate from an accredited college or university. A minimum of 10 years clinical work experience. 2+ years experience in workers’ compensation case management field desired. Must have case management experience with an insurance company.

Computer Skills:
Individual should be proficient using Internet software, and Microsoft applications including Word, Excel and Outlook. Ability to learn other computer systems used in the case management process.

Certificates, Licenses, Registrations:
Active RN license required; plus one of the following credentials CRRN, COHN, CORN, PREFERRED. CCM, CDMS also accepted. If a credential is not held at the time of application, the case manager agrees to be able to sit for an exam in one year.
**Additional state licenses may be required based on assignments**

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Joined: Wed Aug 04, 2010 5:38 am

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