Key Facts

Remote From:

Full time

English

Hard Skills

Care Coordination Return-to-Work Management Case Management Systems Care Planning Documentation Generation Medical Record Management Patient Referral Patient Education And Counseling Clinical Assessments Evaluation Of Care Case Management Systems Data Collection Biomedical Instrumentation Productivity Improvement

Other Skills

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Client Confidentiality
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Quality Assurance
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Communication
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Time Management
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Organizational Skills
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Prioritization

Roles & Responsibilities

Unrestricted Texas nursing license
Telephonic case management experience in workers' compensation (preferred)
Knowledge of HIPAA/PHI laws and confidentiality standards
Excellent communication and organizational skills; ability to work independently and remotely

Requirements:

Provide telephonic outreach for assessment and coordination, including planning, implementing, and coordinating of care
Conduct and document initial assessment with the injured worker, employer and provider; maintain regular contact to formulate a clinical case plan
Coordinate contact with provider, claimant, RTW contact, and claims examiner; review case records, analyze data, and define needs and problems for proactive case management
Facilitate timely return-to-work (RTW) by coordinating with claimant, employer, and physicians; monitor medical appointments and negotiate treatment plans as needed

TRISTAR Insurance Group

Insurance

About TRISTAR Insurance Group

TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

**This is a remote position preferably in Texas. Hours will be 8 am - 5:00 pm Pacific time or EST

**Must have an unrestricted nursing license in TX. experience preferred.

POSITION SUMMARY: The medical case manager provides telephonic case management in a workers’ compensation environment coordinating resources and cost effective options on a case-by case basis to facilitate quality individualized treatment goals and return to work placement.

ESSENTIAL DUTIES AND RESPONSIBILITIES: Possess excellent communication and organizational skills to interface with the client, claimants and staff. Work well independently and set priorities.

Primary responsibilities include:

Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care
Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan

Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner
Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services
Assessment of medical records for appropriateness of treatment and level of care being provided. Referral to the Medical Director if appropriate within the established timeframes
Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians
Maintains contact and communicates updated activity with all parties involved with the case
Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes. Negotiate treatment plan with treating physician

Additional Functions and Responsibilities

Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
Maintain minimum billing and established template documentation standards adhering to URAC standards and company policy and procedures
Reporting billing hours in accordance with case activity and billing practices
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
Other job duties as assigned