Workers Compensation Case Manager

Summary

Join IMG, a leading international medical insurance company, and become a Workers Compensation Case Manager. You will coordinate healthcare for injured workers domestically and internationally, evaluating medical treatment and mitigating risk. This hybrid or remote position requires an active RN license in Indiana and at least two years of work comp case management experience. You will liaise between the insured, carrier, and healthcare team, ensuring compliance with regulations. IMG offers a comprehensive benefits package, including medical, dental, vision, 401k, paid time off, and more. The ideal candidate possesses excellent communication, organizational, and computer skills.

Requirements

• Active RN license in good standing is mandatory
• Minimum two years’ experience as a work comp case manager
• Excellent computer skills, including database knowledge
• Excellent customer service skills and phone etiquette
• Excellent organizational skills and attention to detail
• Qualified candidates must be legally authorized to be employed in the United States

Responsibilities

• Reviews medical services for medical necessity
• Direct and/or re-direct claimant to appropriate approved care
• Negotiate discounts with out-of-net network providers
• Direct healthcare team members to utilize alternative care settings when appropriate
• Identify claimant needs by priority, diagnosis, dollar amount and/or high utilization of medical services and coordinate care to satisfy the carrier, insured, provider, claimant, and medical team
• Document information and status in ACM systems and documents
• Participate in the on-call rotation schedule emergent Certifications, Concurrent Reviews, Retrospective Reviews, and Medical Evacuations/Repatriations including inpatient and outpatient management of assistance cases
• The provision of telephone and email based pre-travel advice
• Direct and/or re-direct members to in-network providers
• Negotiate discounts with out-of-net network providers
• Medical evacuation calls
• Prepare case management reports monthly and as needed
• Use good judgment when evaluating medical cases and confer with Medical Director when appropriate
• Communicate with other members of the team as needed and ensure that information is shared appropriately
• Maintain confidentiality and privacy of all protected health information
• Continue education through relevant reading materials, online courses and/or seminars
• Support and participate in Quality Management activities
• Utilize clinical support tools as indicated
• Maintain a working knowledge of the case management process & standards established by URAC and any applicable state or federal regulations as appropriate for job duties
• Reports & documents complaints when/if received
• Demonstrates excellent communication skills
• Any other job duties or tasks assigned

Preferred Qualifications

• Certified Case Manager preferred (CCM)
• Experience auditing medical charts against itemized medical bills
• Bilingual – Proficient verbal and written communication skills in a foreign language (including but not limited to Spanish, Portuguese, Mandarin, and/or French) a plus but not required

Benefits

• Comprehensive benefits package including Medical/RX/Dental/Vision insurance
• 401k Plan with company match
• Paid Time Off and Company Paid Holidays
• Free employee parking
• On site fitness center
• Casual dress environment
• Tuition reimbursement plan
• Hybrid or Remote working options