Workers' Compensation Case Manager

About Our Company

We're a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Job Description

The individual employed in this position will be responsible for reviewing all Workers' Compensation cases seen at CityMD Urgent Care and Summit Health Multispecialty, evaluating appropriate medical treatment of injured employees with the goal of optimum medical improvement. In addition, this individual will be responsible for spearheading communication among all Workers' Compensation case stakeholders (patient, provider, adjuster/nurse manager, employers, etc.) to effectively manage recovery and return-to-work optimization of all work-related injuries.

Duties and Responsibilities:

The primary duties and responsibilities of the Workers' Compensation Nurse Case Manager are:

• Assess and analyze injured workers' medical reports - comparing to evidence-based treatment guidelines, ensuring disability status is supported by diagnosis, work status/restrictions/treatment plan are appropriate, and documentation is correct/complete.

• Access database to reference employer accounts' modified duty policies and ensure medical reports are communicated and meet client specifications.

• Transmit employee post injury report information to employers via email.

• Communicate with patients in a professional and courteous fashion when needed to discuss changes in work status, restrictions, and treatment plans.

• Maintain productivity on assigned caseloads, which may vary in numbers and/or by state jurisdiction.

• Work with treating physician regarding cases that may need attention or require amendment to ensure appropriate handling and consideration of modified duty is applied to facilitate return-to-work.

• Manage communication (calls, emails) to patients, employers, adjusters and/or nurse case managers regarding any amendments made to case diagnosis, treatment and/or lost time from work.

• Respond to inquiries from employers, adjusters/nurse case managers and patients for documentation or information on Workers' Compensation cases.

• Learn and be proficient in rules that govern HIPAA and release of medical records to patients, employers, payers, and providers.

• Collaborate with centralized Workers' Compensation Teams, Occupational Health Support Teams, Sales Team, Clinical Operations Teams, Revenue Cycle Teams and Medical Records Teams to resolve issues and ensure the highest level of customer satisfaction.

Qualifications:

A candidate's qualifications will include:

• Graduate of an accredited school of nursing and possess a current RN license, Bachelors of Nursing preferred

• Workers' Compensation case management experience preferred

• Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines.

• Must understand Multispecialty terminology and recognize orthopedic diagnoses and diagnostic testing terminology

• Excellent verbal and written communication skills

• Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines

• Experience in the following systems preferred: athena

Net (EMR), Salesforce (CRM)

• Experience working in Microsoft Excel

• Ability to work in a fast-paced, ever-changing environment

• High attention to detail

• Customer orientation and ability to adapt/respond to different types of characters

• Ability to remain professional and courteous with customers at all times

• Works well independently and in a team environment

• Certified Case Manager (CCM) certification a plus

• Bilingual in Spanish a plus

About Our Commitment

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families. Participation in VillageMD's benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.