· Provide telephonic case management of Workers’ Compensation claims by facilitating and coordinating all aspects of the injured worker’s medical care in a timely manner and with consideration to the criteria based model
· Maintain high standard of file documentation to ensure attention to detail and file accuracy
· Interact with strategic partners to obtain or clarify clinical information
· Compares clinical information against the appropriate criteria set
· Authorize medical care and practice medical costs containment skills
· Provide medical authorization in a timely manner
· Based on rotation schedule, handle after hours calls received from on-call phone
· Work collaboratively with team adjuster and assistant to ensure continuity of care
· Assist in the development of internal procedures and training concerning medical case management
· Assist with ad hoc projects as assigned
· Moderate to heavy keying is required
· Bachelor’s degree or equivalent work experience.
· Current Florida RN license to include 3 plus years in nursing and 2 years direct related experience in case management.
· CCM or CRRN with QRP (if does not have, will obtain within 1 year).
· Must possess intermediate PC skills in windows based environment (Word/Excel) and claims management system.
Occasional travel to include site or patient visits.
**Worker's Comp Case Management experience OR Emergency Room, orthopedics, cardiology or neurology experience required.
· Utilization management/cost containment experience.