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Job Title: Medical Case Manager

Job Summary

Nurse liaison who coordinates care and communicates pertinent medical information among the Injured Worker, the Insured, and the Carrier to facilitate appropriate treatment, successful rehabilitation, and return to work. Delivers efficient, cost-effective communication for work injuries, MVAs, liability claims, LTD/STD, and other referred services.

Duties & Responsibilities

• Follow all policies/procedures in the Case Management (CM) plan; retain accountability for the CM process.
• Accept referrals as assigned by the Director of Case Management.
• Make initial contacts per CM plan; schedule initial assessment; obtain date of next physician appointment.
• Confirm assignment with referral source; clarify special handling instructions.
• Build professional relationships with clients; treat claimants with dignity.
• After physician appointments, contact Carrier and Insured per protocol; maintain ongoing communication with Injured Worker, Insured, and Carrier.
• Record data and billing in CaseAnyplace; submit timely monthly reports (Preliminary, Initial, Progress, Closing).
• Attend physician appointments; obtain diagnosis, prognosis, treatment plan, rehab length, estimated RTW (modified/regular duty), and MMI/Full Recovery as appropriate.
• Refer to Vocational Counselor for job analyses (modified/regular duty) when appropriate and approved by Carrier.
• Recommend IME physicians; coordinate and attend IMEs.
• Coordinate transportation as needed.
• Provide translation as needed (for bilingual nurses).
• Monitor treatment plan; attend therapy sessions when appropriate; maintain contact with therapists for updates.
• Request transfer of files to AMC Vocational Counselor when appropriate (LMS, Voc Rehab).
• Assist Carrier/Insured with RTW planning (modified or regular duty).
• Provide information to Defense Attorneys as appropriate.
• Promote teamwork with all AMC staff members.
• Maximize accurate, appropriate billable hours per monthly target (8 hrs/day).
• Maintain licensure/certifications; complete required annual training on time.
• Perform additional professional duties as assigned.
• Retain responsibility for tasks delegated to non-clinical staff.

Qualifications

• Registered Nurse: Current, unrestricted state license; licensed in each state where field case management is provided; able to perform independent assessments within scope.
• Discipline Eligibility: Practices in a U.S. state/territory allowing independent assessment within scope of practice.
• Education: Completion of a nursing program and ongoing CE as required.
• Certification: One or more national certifications within 4 years of hire (e.g., CCM, CRC, CLNC, CRRN) preferred.
• Experience: Two years FTE direct case management for injured workers or two years under supervision preferred.