Job Description

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind®

We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers.

JOB DETAILS

• RN License -- Must have an active RN license in good standing in Indiana
• Location: Hybrid or Remote working options. 
• Corporate office is in Indianapolis, IN
• Relocation Expenses Reimbursed: No
• Qualified candidates must be legally authorized to be employed in the United States. IMG will not be providing sponsorship for employment visa status (e.g., H-1B or TN status) for this position

JOB SUMMARY

The Workers Compensation Case Manager p rovides case management services to coordinate health care for injured workers, both foreign and domestic. Evaluates medical treatment and helps mitigate risk and exposure with appropriateness, and efficiency of the use of health care services, procedures, and facilities. Work as a liaison between the Insured, the insurance carrier and the insured’s healthcare team to meet the requirements of the work injury jurisdiction in the United States and abroad.  

PERKS

• 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

DUTIES AND 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.

QUALIFICATIONS  

• 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.

PREFERRED SKILLS  

• 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

PROFESSIONAL COMPETENCIES

• Communication - Must be able to express ideas clearly, concisely, and logically. Must make effective and persuasive arguments when discussing medical care issues.

• Initiative – proactive in resolving problems, reporting discrepancies, suggesting new ideas and seeking process improvements.
• Judgment - use of good clinical judgment as it relates to medical treatment in case management.
• Flexibility – must be willing to adjust as the industry or job requirements change.
• Teamwork – must work well in a team and help foster a cooperative environment.
• Represent a positive, professional image of the company.

Job Tags

Similar Jobs