Clinical Case Manager
1 day ago
Gratitude Philippines is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a crucial role in ensuring that injured employees receive the appropriate level and intensity of care. Your primary responsibility will be to assess client situations, identify barriers to treatment, and develop medical resolution strategies to achieve maximal medical improvement or optimal outcomes.
About the Role:
In this position, you will work closely with claims adjusters, clients, vendors, supervisors, and other parties to coordinate medical care and return to work initiatives. You will perform clinical assessments, evaluate treatment plans, and engage specialty resources as needed to achieve optimal resolutions. Additionally, you will partner with adjusters to provide input on medical treatment and recovery time to assist in evaluating claim reserves.
Key Responsibilities:
- Perform clinical assessments via information in medical/pharmacy reports and case files;
- Assess client's situation to include psychosocial needs, cultural implications, and support systems in place;
- Objectively and critically assess all information related to the current treatment plan to identify barriers, clarify, or determine realistic goals and objectives;
- Seek potential alternatives and develop medical resolution strategies to achieve maximal medical improvement or optimal outcomes;
- Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim;
- Engage specialty resources as needed to achieve optimal resolutions;
- Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating claim reserves;
Requirements:
- Bachelor's degree in nursing (BSN);
- Active unrestricted RN license that can be validated thru PRC website;
- 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department;
- Written and verbal fluency in English;
- Proficiency in Microsoft Office products including Word, Excel, PowerPoint;
Preferred Qualifications:
- Knowledge of workers' compensation laws and regulations, behavioral health, case management practice, URAC standards, ODG, Utilization review, pharmaceuticals to treat pain, pain management process, drug rehabilitation, state workers compensation guidelines, periods of disability, and treatment needed;
- Leadership/management/motivational skills as well as analytic and strong organizational skills;
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