Medical Case Manager

Cabot Risk Strategies, LLC is a dynamic and highly experienced team of insurance professionals dedicated to delivering quality services to our clients. Our goal is to help our clients effectively manage risk through insured solutions, self-funded solutions or a combination of both. As a full-service insurance brokerage and consulting firm, we also provide our clients a leading employee benefits practice delivering best-in-class employee benefits solutions and services.

Based in Woburn, MA, Cabot Risk Strategies is easily accessed off of 93 and 128, and employs 100+ people. Please visit our web site at www.cabotrisk.com

The Medical Case manager is an integral part of Claims Management Team. Provides injury treatment assessment to assist in the development of return to work and rehabilitation programs. Reviews medical provider requests for specialized testing or treatment for necessity as part of overall medical treatment plan.

Essential Job Functions

• Review assigned lost time cases to confirm the diagnosis and develop a medical assessment of the injury and a return to work plan.
• Use judgment in assessing the medical provider’s recommendation and treatment plan in order to assist in obtaining an optimum treatment outcome.
• Coordinate treatment, expedite requests for tests and medical procedures, and works with the employer and employee to devise a rehabilitation plan.
• Coordinate the return to work plan with the employer, providers, and injured employee.
• Communicate with medical provider(s) to obtain and clarify treatment plans and to discuss alternative treatment options when indicated.
• Contact the medical provider(s), employer, injured employee and rehabilitation specialist to assure recovery is progressing properly and a return to work plan is in progress.
• Provide risk management services to accounts by providing educational seminars, resource information and materials, etc.
• Arrange for the purchase or rental of necessary medical equipment.
• Provide consulting services and recommendations on an as needed basis for Police and Fire Injured-On-Duty claims, general liability claims, bodily injury claims, disability claims, and property and casualty claims.
• Acts as a liaison to facilitate effective claims management of Workers Compensation and/or other disability claims.
• Provide in-service training to claims staff.
• Responsible for monitoring case management and consulting outcomes.
• Review complex medical bills upon request for relatedness to injury/illness.
• Support overall Claims Department with medical expertise as needed.
• Assist all members of the Claims Management Team to assure the adherence to MCC and claim procedures and service standards.
• Provide medical claims management recommendations to the Claim Representative and recommend to Claim Representative a comprehensive treatment plan to include rehabilitation efforts as needed.
• Assist the Claim Representative in formulating and individualizing the medical component of the claim approach and reserve setting as needed.
• Assists the Claim Representative in file preparation for settlement and/or litigation as needed.
• Support casualty claims unit with evaluation of complex injury claims.
• Participate in account claim reviews.
• Properly document assessment of the medical issues.
• Design and implement training/educational programs for the Cabot Risk Strategies staff.
• Provide account orientations and educational seminars.

Minimum Requirements

The following are required to enable the employee to perform the essential functions of the job.

• Skills/knowledge – Superior analytical ability and judgment required for position. Excellent communication skills required. Strong ability to interact with medical providers, employees and employers needed. Must develop and maintain reputation of advocating prompt and adequate medical treatment for injured employees, as well as a managed safe transition back into the workplace. Must be able to maintain good relationships with employers and independent medical providers. Must be a strong team player.
• Education/experience – Registered Nurse licensed in the operational jurisdictions required. BSN or working toward a BSN degree necessary. Three plus years occupational health or rehabilitation background in a hospital or industrial setting needed. Minimum of 3-5 years of Case Management experience preferred. Similar experience in the insurance field would be beneficial. National certification in case management preferred (such as CCM, COHN, COHN-S, AAOHN CM certification, CIRS, CRC, CDMS, etc.)