Telephonic Case Manager (Compact & Pennsylvania Licenses required)
Location: Los Angeles
Posted on: November 22, 2021
The Enlyte Family of Businesses
Mitchell - Genex - Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an
organization unlike any other in the Property & Casualty industry,
bringing together three great businesses with a shared vision of
using technology innovation, clinical services and network
solutions to help our customers and the people they serve. Our
suite of products and services enable our employees to help people
recover from challenging life events, while providing opportunities
for meaningful impact and career growth.
This is a full-time, remote position and can be located anywhere in
The Telephonic Case Manager provides case management services to
clients. The Case Manager assesses and documents case activities in
a timely manner, facilitates timely return to work, reviews medical
aspects of claims, recommends diagnostic procedures and testing,
and coordinates second opinions. The Case Manager interacts with
insurance providers, treatment providers, and the employer and
client to ensure the success of the treatment plan. The Case
Manager also evaluates the progress of the treatment and makes
necessary adjustments to it. You will be responsible for managing
an average of 60-70 cases per month. The Case Manager:
Assesses, plans, coordinates, implements and evaluates
injured/disabled individuals involved in the medical case
Provides case management services to injured employees on behalf of
Facilitates communication with third party payers, providers,
injured employees and employers to reduce disability costs.
Provides goals that are customer/client-oriented, results-oriented,
quality-oriented and in accordance with state-specific case
management requirements within the workers' compensation insurance
Provides comprehensive review of available medical records to
assess for case management value and identify complex medical
Uses clinical experience, knowledge, evidenced based guidelines,
and other resources to proactively evaluate the medical and
disability status in order to assist adjuster in appropriately
Analyzes clinical information to identify care needs and strategize
with all parties to create common goals in order to reach maximum
medical improvement and to promote safe return to work for the
injured employee. Based on this analysis, develops pro-active
action plans to outline expected barriers and recommends
Communicates and collaborates with the insurance carrier to control
high medical costs by providing updates on condition changes and
Follows specific account instructions regarding timeframes to
provide reports to clients and formats.
Documents savings on the case concurrently while the case is open
and describes value added to the case in closing summary.
Understands and complies with current industry accepted case
Stays informed and complies with state/federal legislation as it
applies to case management for an assigned geographic region.
Provides leadership and assistance to co-workers.
Reports billing hours in accordance with case activity and billing
Stays informed of healthcare industry current practices and
Licenses or Certifications: Current, unencumbered Registered Nurse
license required; CCM, COHN, CDMS, or CRRN preferred. (CCM must be
obtained within 1 year of hire)
Worker's compensation or disability management experience
Proven experience in Case Management is preferred but not
Multi-state knowledge/experience is preferred.
Minimum of one year clinical experience in a hospital setting.
Experience in orthopedics, neurology, rehabilitation and/or
internal medicine is preferred.
Ability to coordinate the individual's treatment program while
maximizing cost containment.
Written Abilities: Proficient grammar, sentence structure and
written communication skills are required.
Technical Experience: Knowledge of basic computer skills including
Excel, Word, and Outlook Email is required. You will also need
direct access to the internet.
Spanish speaking is a plus.
Home Office Requirements:
Requires DSL, fiber or cable internet connection from home. 1 Mbps
preferred or better.
Home office must be HIPAA compliant.
We're committed to supporting your ultimate well-being through our
total compensation package offerings that support your health,
wealth and self. These offerings include Medical, Dental, Vision,
Health Savings Accounts / Flexible Spending Accounts, Life and
AD&D Insurance, 401(k), Tuition Reimbursement, and an array of
resources that encourage a lifetime of healthier living. - The
Company is an equal opportunity employer, values the diversity of
our workforce and the knowledge of our people. The Company does not
discriminate against an applicant or employee on the basis of race,
color, religion, national origin, ancestry, sex/gender, age,
physical or mental disability, military or veteran status, genetic
information, sexual orientation, gender identity, gender
expression, marital status, or any other characteristic protected
by applicable federal, state or local law. - #LI-NJ1 #LI-Remote
Keywords: Coventry, Los Angeles , Telephonic Case Manager (Compact & Pennsylvania Licenses required), Executive , Los Angeles, California
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