Corporate Lead Case Manager

The Corporate Lead Case Manager is responsible for comprehensive case management of assigned case files, acting as a resource for all involved parties. Creates flexible, cost-effective options for work-injured individuals to facilitate quality of care, to create individualized treatment goals, and to achieve the best possible outcomes. Responsible for assuring the claimants' care is appropriate, cost effective and leads toward rapid and safe return to work and maximum medical improvement.

• Reviews all assigned files to assess the claimant's medical needs, work status and present condition to develop and document an action plan for each referred claim.
• Acts as a facilitator to injured worker, employer, provider, adjuster, and attorney where allowed, fostering non-adversarial relationships while moving towards maximum medical improvement, safe early return to work, and file closure.
• Reviews all medical records/documentation for medical necessity and appropriateness of care. Works with all parties involved in the management of the claim to formulate a plan for rapid, safe, and whenever possible, early return to work.
• Participates in problem solving to develop an effective strategy for claim closure.
• Maintains the file in accordance with CCMSI's claims handling guidelines and incorporates the essential activities of case management as defined by his/her certification guidelines throughout the medical case management process on each file.
• Develops the medical case management plan for each claim in conjunction with the standards. Each managed claim should contain individually focused, functionally oriented treatment plans. Maintains a close working relationship with all parties involved in the claim as allowed per state jurisdiction.
• Makes recommendations for referrals when necessary and appropriate, for independent medical evaluation, treatment, consultation, second opinion, site evaluations, etc.
• Supports and fosters a team building environments for all internal and external customers, assuring that their needs are met in a timely and efficient manner.
• Performs other duties as assigned.
• Willing to work 5 days a week and after clinic hours call, when necessary.

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 abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• BSN with 3 to 5 years of clinical experience related to Trauma, Rehabilitation Therapy, Orthopedics, Workers' Compensation Occupational Medicine Medical Surgical.
• Excellent verbal and written communication and interpersonal skills required.
• Ability to manage multiple and changing priorities with skill and dignity.
• Attention to detail, planning and documentation.
• Discretion and confidentiality are a must.
• Knowledge of case management philosophy, process, outcomes, and goals.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing both internally and externally.
• Supervise case management duties of up to 12 FTEs of medical staff to include Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Vocational Nurses or Medical Assistants.
• 5 FTE case manager direct reports
• Proficient with Microsoft Office programs.
• Current Jurisdictional Nursing license required
• Active TWIC card or willingness to obtain one.

• RN
• COHN-S
• Certification pursuant to US DOT requirements for urine drug screen collections and breathe alcohol screening.
• CAOHC hearing conservation certification.
• Pulmonary Function testing certification.
• Experience with FIT testing.
• Proficiency with SAP and Cority are desirable.
• Proficient with ODG by MCG

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