Case Management & Coordination
Manage a high-volume caseload of complex medical personal injury (PI) cases from intake to closure.
Oversee a high volume caseload of workers compensation cases from intake to closure
Coordinate with providers, attorneys, insurance adjusters, and patients to ensure timely medical care and accurate billing.
Monitor patient progress, review medical records.
Identify and address barriers to care while maintaining compliance with healthcare and legal guidelines.
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Collaboration & Communication
Serve as a liaison between clinical providers, legal teams, insurance carriers, and internal departments.
Maintain strong communication with all parties to facilitate resolution of medical and financial issues.
Represent the department in interdisciplinary meetings and case conferences.
Compliance & Process Improvement
Ensure adherence to HIPAA, state regulations, and internal case management policies.
Participate in audits, case reviews, and data analysis to identify trends and opportunities for improvement.
Contribute to the development of policies, workflows, and training materials.
Education:
Bachelor’s degree in Health Administration, or a related healthcare field required.
Licensure/Certification:
Certification in Case Management (CCM, ACM, or equivalent) strongly desired.
Experience:
Minimum 5–7 years of experience in medical case management, with at least 3 years in personal injury (PI), worker’s compensation, or insurance-based medical review.
Demonstrated experience managing complex clinical cases and working with multidisciplinary teams.
Prior supervisory or senior-level experience preferred.
Skills & Competencies:
Advanced knowledge of medical terminology, treatment protocols, and personal injury documentation standards.
Strong analytical, critical thinking, and negotiation skills.
Exceptional written and verbal communication abilities.
Proficiency in EMR systems, case management software, and Microsoft Office Suite.
High attention to detail and ability to manage multiple priorities under tight deadlines.
Hybrid or remote work environment available depending on organizational policy.
May require occasional travel to provider offices, court hearings, or settlement conferences.
Prolonged periods of sitting and computer use.
Occasional lifting of files or materials up to 20 pounds.
Competitive; commensurate with experience and qualifications.