Case Manager 2

GENEX Services in Cincinnati, OH

  • Type: Full Time
position filled
Mitchell & Genex have Merged
Mitchell is a trusted software and service provider to the Property & Casualty Claims and collision repair industries as well as risk management professionals. We provide technology and services that simplify claims handling, repair processes and pharmacy transactions with best in class clinical management and cost containment solutions. Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, reducing health care costs and disability expenses for our customers.

Together, we bring two industry leaders in software and service committed to delivering a first-class experience to the customers, partners and markets we serve. We offer a complete suite of technology enabled solutions, and a proven managed care service mix, allowing us to deliver better outcomes to our clients for their businesses, their employees and their customers.

Job Description

The Telephonic Nurse Case Manager provides case management services to clients. Assesses and documents case activities in a timely manner, facilitates timely return to work, reviews medical aspects of claims, recommends diagnostic procedures and testing, and coordinates second opinions. The NCM interacts with insurance providers, treatment providers, and employer and client to ensure the success of the treatment plan. The NCM also evaluates the progress of the treatment and makes necessary adjustments to it.
Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process.
Provides case management services to injured employees on behalf of carriers/employers.
Facilitates communication with third party payers, providers, injured employees and employers to reduce disability costs.
Provides goals that are customer/client-oriented, results-oriented, quality- oriented and in accordance with state-specific case management requirements within the workers' compensation insurance industry.
Provides comprehensive review of available medical records to assess for case management value and identify complex medical conditions.
Uses clinical experience, knowledge, evidenced based guidelines, and other resources to proactively evaluate the medical and disability status in order to assist adjuster in appropriately setting reserves.
Analyzes clinical information to identify care needs and strategize with all parties to create common goals in order to reach maximum medical improvement and to promote safe return to work for the injured employee. Based on this analysis, develops pro-active action plans to outline expected barriers and recommend cost-saving solutions.
Communicates and collaborates with the insurance carrier to control high medical costs by providing updates on condition changes and treatment expectations.
Follows specific account instructions regarding timeframes to provide reports to clients and formats.
Documents savings on case concurrently while the case is open and describes value added to case in closing summary.
Understands and complies with current industry accepted case management guidelines.
Stays informed and complies with state/federal legislation as it applies to case management for an assigned geographic region.
Provides leadership and assistance to co-workers.
Reporting billing hours in accordance with case activity and billing practices.
Stays informed of healthcare industry current practices and trends.

Knowledge: You will be responsible for managing an average of 50 cases per month. A clinical background related to trauma, neurological, orthopedic, or occupational health nursing is required. Worker’s compensation experience is required.

Job Complexity: Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with senior internal and external personnel in own area of expertise.

Supervision: You will receive general instructions on new assignments and little instruction on day-to-day work.

Qualifications
*must be located in the Cincinnati, Ohio area*
Worker’s compensation or disability management experience.
Proven experience in Nurse Case Management.
Ohio State Fund workers compensation case management experience highly preferred.
Ability to coordinate the individual’s treatment program while maximizing cost containment.
Two to five years’ clinical experience is required. Experience in orthopedics, neurology, rehabilitation and/or internal medicine is preferred.

Written Abilities: Proficient grammar, sentence structure and written communication skills are required.
Technical Experience: Knowledge of basic computer skills including Excel, Word, and Outlook Email is required. You will also need direct access to the internet.
Spanish speaking is a plus.
Licenses or Certifications: All applicants must be a Registered Nurse. CCM, COHN preferred or able to sit for exam within one year of employment.
Location: Cincinnati, Ohio

Physical Requirements: Candidate must be able to sit the majority of an 8 hour day with the exception of lunch and break times. Candidate must be able to keyboard the majority of an 8 hour day with the exception of lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe office environment. Home office must be HIPPA compliant.

*Requires DSL, fiber or cable internet connection from home. 1 mbps preferred or better.*

Mitchell International, an equal opportunity employer, values the diversity of our workforce and the knowledge of our people.  Mitchell will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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