Eagle One Case Management Solutions, Inc.
Job Title: Medical Case Manager
Reports To: Supervisor
Date: December 2017
Provides nursing, clinical, casework services by performing the following duties:
Essential Duties and Job Responsibilities:
• Effectively manages a caseload of 22-25 active field case management files if full field, 45-55 telephonic case management files, or 35-45 if mixed TCM/FCM depending on complexity. Part time employees handle case load of 12-18 files dependent on acuity and determine by supervisor and medical manager.
• All full time medical case managers are required to bill a minimum of 40 hours per week. Part time to be discussed and decided upon by supervisor.
• Maintains the Outlook calendar by keeping all meetings and/or appointments current and documenting changes as they occur, throughout the week, that will be available for weekly review
• Tasks must be kept current and be updated on a daily basis
• Attends and participates in all mandatory meetings, training or corporate events, within person or through electronic means, as required
• Initial four-point contacts must be made within 24-48 hours from the date of the referral and the initial email must be sent immediately thereafter
• Timely closure of files with internal charting complete and up to date, including impact points
• Understands and demonstrates the ability to apply Eagle One™ case management protocols
• Consults with Manager and internally roundtables on complex cases, claim barriers and on resolution planning.
• Demonstrates the ability to effectively create medical timelines
• Prepares case summaries for account claim reviews
• Responsible for maintaining a complete medical file which is kept in chronological order with no duplication of information in a paperless format
• Alerts Manager of any requests to deviate from Eagle One™ or account specific protocols and obtains approval to proceed as necessary
• Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.)
• Responsible for initial and ongoing analysis of the diagnosis as it relates to the work injury and the medical treatment rendered
• Provides expert consultation for interpretation of medical information and how it impacts the case
• Projects anticipated dates for modified and full-duty work releases utilizing disability/medical criteria and documenting any deviations at each appointment
• Continually addresses physical job demands and job availability at physician appointments to encourage appropriate work release
• Contacts medical providers within 24 hours of appointments to obtain disability and medical status
• Determines and documents appropriateness of medical treatment and whether or not the treatment meets disability/medical criteria throughout claim duration
• Updates employer and any other appropriate parties with any change in disability or medical status and appointment information within 24 hours of appointment date and coordinates return to work per protocol
• Adheres to jurisdictional rules and regulations and applies to each case as appropriate
• Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within an average 2 hour radius from home office.
• Meets or exceeds Eagle One™ guidelines for return-to-work outcomes and medical closure durations
• Involved in Public Health community wellness fairs and clinics as needed
• If PRN case manager, perform tasks as requested and attend appointments as needed per field guidelines.
To perform this job successfully, an individual must be detail-oriented with exceptional communication and interpersonal skills. Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
• Active RN licensure in state of employment
• Bachelor’s Degree preferred
• Additional certifications a plus (i.e. CCM, CDMS, CLNC)
Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions.
To perform this job successfully, an individual should have knowledge of Microsoft Windows/Office (Word, Excel and Outlook), be able to navigate the internet for the purpose of research and have a general/overall working knowledge of computer navigation. Typing skills of 45+ wpm
• Knowledge of workers’ compensation jurisdictional rules/regulations a plus
• Ability to work in a fast-paced environment
• Strong organizational skills a must
• Excellent written and verbal communication skills
• Excellent customer service skills required
• Previous case management experience a plus
• Clinical experience in an orthopedic or occupational health setting a plus
• Bilingual a plus
• Valid driver’s license and ability to drive to/from appointments if hired as a field case manager
To perform the job successfully, an individual should demonstrate the following competencies:
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.
Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
Supervisory Responsibilities: This job has no supervisory responsibilities.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee must frequently lift and/or move up to 10 pounds.
While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; sit and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.