Case Management Program Manager
Company Name:
Comprehensive Health Services, Inc.
Case Management Program Manager
Tracking Code
2802-120
Job Description
CHSi has more than 35 years' experience applying best practices to help employers to reduce health care costs, reduce lost time, assure 100% Medical compliance through tailored services to various workforce configurations--consolidated, dispersed, mobile, or virtual. Employing a three-fold service delivery model, CHSi fulfills occupational health services through worksite health programs, extensive national network of health care providers, and Medical readiness teams domestically and internationally.
THIS IS A NOTIONAL POSITION, CONTINGENT UPON CONTRACT AWARD
SCOPE:
The Case Management Program Manager is responsible for facilitating, evaluating and coordinating the delivery of high-quality, timely and cost-effective medical treatment and services as needed by an injured or ill employees of assigned corporate clients throughout the United States (Situations such as short and long term disability, workers compensation, FMLA, etc.). Reports to the Program Manager.
Qualifications:
Bachelor's degree preferred. Fully unencumbered Registered Nurse license in the State where permanently assigned. Five or more years' experience in clinical nursing practice, preferably in Occupational Healthcare Must exhibit acute attention to detail and a sense of responsibility. Five or more years' experience required in managing others performing such work.
Solid skills with computer and common office equipment to include the ability to work with and among various databases and software programs. Ability to organize own work, managing assigned case load effectively and autonomously. Must have the ability to read, analyze interpret and produce medical records and reports. Strong oral, written and interpersonal communication skills required. Current knowledge of Worker's Compensation, Disability, Family & Medical Leave Act and OSHA guidelines required. Familiarity with employer disability/health plans required.
DUTIES AND
Responsibilities:
Initiates in-person or assessment upon notice/referral to Case Management; obtaining medical history and current medical status.
Obtains and reviews actual medical documentation to determine if subjective, objective evidence support disability.
Contacts the treating physician to obtain details regarding the diagnosis, prognosis, treatment plan; assessing reasonableness and appropriateness.
Measures physician estimates for Return to Work (RTW) versus guidelines for disability and duration.
Evaluates the employee's ability to perform essential functions of their job.
Assesses the employee's understanding of the medical condition and treatment plan.
In concert with employee and medical providers, formulates an appropriate and comprehensive plan of action for the rehabilitative process; providing for best interests of the employee and employer and using disability guidelines for time-specific anticipated progress in rehabilitation from a specific injury/illness.
Sets expectations for employee compliance with Case Management Program.
Sets expectations for treating physicians, monitoring and evaluating outcomes and quality of services.
Maintains contact with employee to track progress and provide education and support.
Identifies and coordinates referral to appropriate specialty; coordinates all aspects of treatment plan.
Utilizes Care Maps to manage treatment and facilitate recovery.
Follows up on and revises plans as necessary according to guidelines.
Facilitates the involvement of the treating physician through regular contact, keeping the employee focused on RTW.
Communicates with Worker's Compensation or Disability Insurance Carrier and employer to provide weekly updates regarding disability status, progress and return to pre-injury/illness occupations.
Educates treating providers regarding job duties of employee; reviews essential job functions with treating physician in order to obtain release for RTW; highlighting benefits of proactive return to modified work.
Plans and conducts worksite walk-through for assessment and understanding of all jobs, specific requirements, and essential functions of jobs. Identifies need for functional assessment - ergonomic evaluation of job duties.
Keeps current with assigned client-employer's RTW program.
Facilitates communication - dialogue between employee and employer.
Coordinates and facilitates RTW when medically appropriate - modified, transitional or full duty.
Coordinates efforts with managers and RTW Coordinator to facilitate accommodations and work restrictions.
Offers consultation services in utilization management when requested by claims analysts / TPA.
Attends physician visits with injured employees as indicated to provide opportunities for collaboration and coordination of services and treatment plans; dialogues with the physician to facilitate appropriate medical treatment and facilitates RTW.
Provides medical oversight and absence management through duration of disability.
Maintains and fosters the best possible relationships with the medical community and contracted providers to facilitate the most appropriate, cost-effective care, equipment, and supplies for the employee.
Evaluates medical disabilities and prepares effective and pro-active solutions to facilitate early and appropriate treatment and timely restoration of function and pre-injury abilities.
Maintains confidentiality of employee's medical, disability, and demographic information.
Refers employee to their employer's EAP, Wellness or Disease Management resources as appropriate.
Identifies Employee Relations issues and reports to employer's Human Resources as appropriate.
Effectively manages assigned case load.
Documents case management activities - using case management software- clearly and concisely.
Presents cases as appropriate for review and direction by assigned Physician or Physician Assistant.
Prepares cost benefit information for individual cases.
Prepares and submits case management reports as required.
Prepare for and presents case status updates at client meetings as required.
Other duties and projects as assigned and requested.
OTHER DUTIES:
May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements.
Supports marketing and sales objectives and efforts as requested.
Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training and goals. Ensures safe operating conditions within area of responsibility. Encourages co-workers to work safely. Identifies close calls and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area.
Assists in active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards.
May serve on the OSHA VPP, Safety, and Wellness Committees.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class.
Job Location
Anchorage, Alaska, United States
Position Type
Full-Time/Regular
Employment Type
Full time RegularEstimated Salary: $20 to $28 per hour based on qualifications.
Comprehensive Health Services, Inc.
Case Management Program Manager
Tracking Code
2802-120
Job Description
CHSi has more than 35 years' experience applying best practices to help employers to reduce health care costs, reduce lost time, assure 100% Medical compliance through tailored services to various workforce configurations--consolidated, dispersed, mobile, or virtual. Employing a three-fold service delivery model, CHSi fulfills occupational health services through worksite health programs, extensive national network of health care providers, and Medical readiness teams domestically and internationally.
THIS IS A NOTIONAL POSITION, CONTINGENT UPON CONTRACT AWARD
SCOPE:
The Case Management Program Manager is responsible for facilitating, evaluating and coordinating the delivery of high-quality, timely and cost-effective medical treatment and services as needed by an injured or ill employees of assigned corporate clients throughout the United States (Situations such as short and long term disability, workers compensation, FMLA, etc.). Reports to the Program Manager.
Qualifications:
Bachelor's degree preferred. Fully unencumbered Registered Nurse license in the State where permanently assigned. Five or more years' experience in clinical nursing practice, preferably in Occupational Healthcare Must exhibit acute attention to detail and a sense of responsibility. Five or more years' experience required in managing others performing such work.
Solid skills with computer and common office equipment to include the ability to work with and among various databases and software programs. Ability to organize own work, managing assigned case load effectively and autonomously. Must have the ability to read, analyze interpret and produce medical records and reports. Strong oral, written and interpersonal communication skills required. Current knowledge of Worker's Compensation, Disability, Family & Medical Leave Act and OSHA guidelines required. Familiarity with employer disability/health plans required.
DUTIES AND
Responsibilities:
Initiates in-person or assessment upon notice/referral to Case Management; obtaining medical history and current medical status.
Obtains and reviews actual medical documentation to determine if subjective, objective evidence support disability.
Contacts the treating physician to obtain details regarding the diagnosis, prognosis, treatment plan; assessing reasonableness and appropriateness.
Measures physician estimates for Return to Work (RTW) versus guidelines for disability and duration.
Evaluates the employee's ability to perform essential functions of their job.
Assesses the employee's understanding of the medical condition and treatment plan.
In concert with employee and medical providers, formulates an appropriate and comprehensive plan of action for the rehabilitative process; providing for best interests of the employee and employer and using disability guidelines for time-specific anticipated progress in rehabilitation from a specific injury/illness.
Sets expectations for employee compliance with Case Management Program.
Sets expectations for treating physicians, monitoring and evaluating outcomes and quality of services.
Maintains contact with employee to track progress and provide education and support.
Identifies and coordinates referral to appropriate specialty; coordinates all aspects of treatment plan.
Utilizes Care Maps to manage treatment and facilitate recovery.
Follows up on and revises plans as necessary according to guidelines.
Facilitates the involvement of the treating physician through regular contact, keeping the employee focused on RTW.
Communicates with Worker's Compensation or Disability Insurance Carrier and employer to provide weekly updates regarding disability status, progress and return to pre-injury/illness occupations.
Educates treating providers regarding job duties of employee; reviews essential job functions with treating physician in order to obtain release for RTW; highlighting benefits of proactive return to modified work.
Plans and conducts worksite walk-through for assessment and understanding of all jobs, specific requirements, and essential functions of jobs. Identifies need for functional assessment - ergonomic evaluation of job duties.
Keeps current with assigned client-employer's RTW program.
Facilitates communication - dialogue between employee and employer.
Coordinates and facilitates RTW when medically appropriate - modified, transitional or full duty.
Coordinates efforts with managers and RTW Coordinator to facilitate accommodations and work restrictions.
Offers consultation services in utilization management when requested by claims analysts / TPA.
Attends physician visits with injured employees as indicated to provide opportunities for collaboration and coordination of services and treatment plans; dialogues with the physician to facilitate appropriate medical treatment and facilitates RTW.
Provides medical oversight and absence management through duration of disability.
Maintains and fosters the best possible relationships with the medical community and contracted providers to facilitate the most appropriate, cost-effective care, equipment, and supplies for the employee.
Evaluates medical disabilities and prepares effective and pro-active solutions to facilitate early and appropriate treatment and timely restoration of function and pre-injury abilities.
Maintains confidentiality of employee's medical, disability, and demographic information.
Refers employee to their employer's EAP, Wellness or Disease Management resources as appropriate.
Identifies Employee Relations issues and reports to employer's Human Resources as appropriate.
Effectively manages assigned case load.
Documents case management activities - using case management software- clearly and concisely.
Presents cases as appropriate for review and direction by assigned Physician or Physician Assistant.
Prepares cost benefit information for individual cases.
Prepares and submits case management reports as required.
Prepare for and presents case status updates at client meetings as required.
Other duties and projects as assigned and requested.
OTHER DUTIES:
May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements.
Supports marketing and sales objectives and efforts as requested.
Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training and goals. Ensures safe operating conditions within area of responsibility. Encourages co-workers to work safely. Identifies close calls and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area.
Assists in active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards.
May serve on the OSHA VPP, Safety, and Wellness Committees.
We are an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class.
Job Location
Anchorage, Alaska, United States
Position Type
Full-Time/Regular
Employment Type
Full time RegularEstimated Salary: $20 to $28 per hour based on qualifications.
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