Medical Case Manager

Auto Injury Case Manager (Community Based) Lansing and West Michigan (Grand Rapids, Battle Creek, Kalamazoo)
SUMMARY: A Case Manager (CM) is responsible for applying medical knowledge in assisting injured clients to assess, evaluate, plan, implement and oversee the treatment appropriateness for catastrophic injuries based upon evidence-based guidelines. The CM utilizes clinical knowledge to evaluate the medical and disability needs of the client against relevant policies, facilitate coordination of the client’s medical treatment. The CM engages the client and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers and other members of the treatment team. The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes.
CASE MANAGER JOB RESPONSIBILITIES:
-Accomplishes clients’ care by assessing treatment needs; developing, monitoring, and evaluating treatment plans and progress; facilitating interdisciplinary approaches; monitoring staff performance.
-Admits new clients by reviewing records and conducting a clinical interview to determine the need for therapeutic medical, psycho-social, and psychiatric evaluations, reviewing therapist evaluations, treatment objectives, and plans.
-Attends key medical provider appointments alongside the client to advocate for needs, represent the injury and develop the treatment plan.
-Establishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including in home care and transportation.
-Seeks consultation from physicians, clinical and other disciplines and departments as required to expedite treatment.
-Maintains clients’ records by generating case notes, logging events and progress.
-Communicates clients’ progress by authoring progress notes on a monthly or quarterly basis or as requested by the insurer.
-Prepares clients’ discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members; providing resources.
-Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
EDUCATION, EXPERIENCE, AND LICENSING REQUIREMENTS:
-Baccalaureate or master’s degree from an accredited institution, in a Health or Human Services Field.
-Current and unrestricted state licensure in your discipline.
-CCM Certification or progress toward CCM is highly preferred and encouraged.
-Proven working experience in case management, including as a nurse, medical, mental health care manager or a related job.
-Must have a valid in-state driver’s license, provide current registration and insurance, and have an acceptable driving record.
-Must obtain and maintain professional liability insurance. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
-Knowledge of clinical care and jurisdictional requirements
-Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
-Strong time management skills.
-Excellent oral and written communication, customer service, written report preparation, human relations and decision-making skills are required.
-Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making.
-Computer Literacy (Electronic calendars, email, spreadsheets, databases, electronic health records).
WORKING CONDITIONS AND PHYSICAL EFFORT:
-The CM position is community based. Additional client work is normally performed in the following community settings: Doctors’ offices, therapy clinics, hospitals, occasional home visits with the client.
-CM maintains a home office for administrative activities.
-CM must provide own devices such as computer and cell phone.
-CM must accept and agree to Rehabilitory Solutions Technology and Security Guidelines.
-Extremely limited physical effort required (occasionally lifting and/or carrying such articles as laptop computers, client files, etc.)
-There are no “hands on” responsibilities to the client.
-Ability to ambulate into and out of provider locations with or without assistance or accommodations.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.