Medical Case Manager

Full-time - Entry Level

Blue Springs, MO

Health and Personal Care Retailers

About the position

As a Medical Case Manager at Core Medical Center, you will play a crucial role in managing and fostering relationships among various stakeholders involved in workers' compensation and motor vehicle accident cases. Your primary responsibility will be to ensure that patients are well-informed about their care plans and that they adhere to these plans throughout their treatment. You will be the key point of contact for employers, adjusters, nurse case managers, attorneys, funding companies, and healthcare providers, ensuring timely communication and documentation among all parties involved. Your goal is to simplify the workers' compensation process for all stakeholders, making it seamless and efficient. In this role, you will handle incoming and outgoing referrals for state and federal workers' compensation and motor vehicle accident cases. This includes requesting prior authorizations, submitting certified liens, and managing demographic and payer information. You will conduct screenings and intakes for federal compensation and motor vehicle accident cases, ensuring that all necessary documentation is completed and communicated effectively. You will also be responsible for drafting letters for federal workers' compensation and managing all paperwork related to these cases. Your performance objectives will include timely submission and responses to all referrals and maintaining a high standard of care for patients. You will be expected to build strong relationships with all parties involved, ensuring that patients feel respected and cared for while adhering to best practices. You will also be responsible for tracking referral sources and setting up meetings to enhance relationships with them. Your ability to navigate various insurance websites and ECOMP sites will be essential for submitting records and other pertinent paperwork. Core Medical Center is committed to providing comprehensive multi-specialty care, and as a Medical Case Manager, you will be integral to achieving this mission. You will work independently and collaboratively within a team, demonstrating excellent organizational and communication skills while maintaining a professional demeanor at all times.

Responsibilities

• Manage and foster relationships between employers, adjusters, nurse case managers, attorneys, funding companies, and providers.
• Ensure patients are educated about their care plans and maintain compliance throughout the process.
• Provide timely communication and documentation to all parties involved, especially the referral source.
• Handle incoming and outgoing referrals for state, federal, and motor vehicle accident cases.
• Request prior authorizations for state and federal compensation and funding companies.
• Submit certified liens for motor vehicle accident cases.
• Input demographic and payer information accurately.
• Conduct screenings and intakes for federal compensation and motor vehicle accident cases.
• Communicate off-site approvals, billing, coding, and collection department updates.
• Draft letters for federal workers' compensation cases and manage all related paperwork.
• Track referral sources and set up meetings to enhance relationships with them.
• Navigate various insurance websites and ECOMP sites to upload necessary documentation.
• Keep track of all cases using specific systems to monitor KPIs and case progress.
• Submit records within 24 hours of completed visits and maintain constant communication with stakeholders.
• Participate in meetings with ownership and referral sources to strengthen relationships.
• Communicate and respond to funding companies and submit bids for care based on providers' care plans.

Requirements

• 2 years of experience in Workers' Compensation (preferred).
• Knowledge of workers' compensation law, ICD-10, and CPT coding.
• Strong organizational skills to manage multiple cases and documentation.
• Excellent communication skills, both oral and written.
• Ability to build and maintain relationships with various stakeholders.
• Self-starter who can work independently and effectively in ambiguous situations.
• Strong planning, organizing, and prioritizing skills.

Nice-to-haves

• Experience in healthcare administration or case management.
• Familiarity with electronic health records (EHR) systems.
• Knowledge of insurance processes and regulations.

Benefits

• Health insurance
• Dental insurance
• Paid time off
• 401(k) matching
• Flexible schedule