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 U.S.
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. The Case Manager:
- Assesses, plans, coordinates, implements and evaluates injured/disabled individuals involved in the medical case management process.
- Provides case management services to injured employees on behalf of carriers/employers.
- 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 industry.
- Provides comprehensive review of available medical records to assess for case management value and identify complex medical conditions.
- 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 setting reserves.
- 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 cost-saving solutions.
- Communicates and collaborates with the insurance carrier to control high medical costs by providing updates on condition changes and treatment expectations.
- 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 management guidelines.
- 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 practices.
- Stays informed of healthcare industry current practices and trends.
Licenses or Certifications: Current, unencumbered Registered Nurse license required; CCM, COHN, CDMS, or CRRN required or scheduled within one year of hire.
- Worker’s compensation or disability management experience highly desired.
- Proven experience in Case Management is preferred but not required.
- 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