Telephonic Medical Case Manager | Workers' Comp

TRISTAR MANAGED CARE INC; Summerville (SC); On-site; USD 65,000 - 90,000; Full time

Job summary

TRISTAR MANAGED CARE INC is seeking a Medical Case Manager to provide telephonic case management in a workers’ compensation environment, coordinating resources and cost‑effective options to support quality individualized treatment goals and return to work placement.

The role emphasizes assessment, planning, intervention, and collaboration with claimants, employers, and providers; requires RN licensure and a CCM credential, strong communication, organizational skills, and proficiency with

Qualifications

• Three or more years of diverse clinical experience in acute care.
• Two or more years of medical case management or workers’ compensation experience; Workers’ Compensation background preferred.
• Knowledge of utilization management, quality improvement, discharge planning, and cost management.
• Ability to solve practical problems and work independently with minimal supervision.

Responsibilities

• Provide telephonic outreach for assessment, and follow-up for case communication and coordination to include assessing, planning, implementing, coordinating of care.
• Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan.
• Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner.
• Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services.
• Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians.
• Maintains contact and communicates updated activity with all parties involved with the case.

Skills

Communication

Organizational skills

Telephonic CM

Data analysis

Microsoft Office

Education

RN license

CCM certification preferred

Bachelor's degree in Nursing or related field

Tools

Microsoft Office

Job description

TRISTAR MANAGED CARE INC is seeking a Medical Case Manager to provide telephonic case management in a workers’ compensation environment, coordinating resources and cost‑effective options to support quality individualized treatment goals and return to work placement.

The role emphasizes assessment, planning, intervention, and collaboration with claimants, employers, and providers; requires RN licensure and a CCM credential, strong communication, organizational skills, and proficiency with