Telephonic Case Manager

6 months ago

Mississauga, Canada Genex Services Full time

Company Overview:
**_ 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.

**Job Description**:

- **This is a remote opportunity, but the individual must live in Canada.**

The Telephonic Case Manager provides case management services to clients. 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 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.
- Responsible for assessment, planning, coordination, implementation and evaluation of 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 province-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 recommend 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 case concurrently while the case is open and describes value added to case in closing summary.
- Understands and complies with current industry accepted case management guidelines.
- Stays informed and complied with province/federal legislation as it applies to case management for an assigned geographic region.
- Provides leadership and assistance to co-workers.
- Reporting billing hours in accordance with case activity and billing practices.
- Stays informed of healthcare industry current practices and trends.

Knowledge: You will be responsible for managing up to 55 cases per month. A clinical background related to trauma, neurological, orthopedic, or occupational health nursing is required. Worker’s compensation experience is required.

Job Complexity: Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with senior internal and external personnel in own area of expertise.

Supervision: You will receive general instructions on new assignments and little instruction on day-to-day work.

Qualifications:

- EDUCATION: Diploma, Associate or bachelor’s degree in nursing required. Masters level and/or advanced study in a health-related field desired.
- EXPERIENCE: Minimum of two years’ clinical nursing practice if bachelor’s degree or higher in Nursing OR holds certification as a Case Manager; minimum of three years’ clinical nursing practice required if Diploma or Associates Degree in nursing AND currently does not hold certification as a Case Manager. Workers’ compensation-related experience preferred.
- MINIMUM QUALIFICATIONS**:Registered nurse** with current, valid registration.
- OTHER QUALIFICATIONS: 5+ years related clinical experience preferred. Prior Case Management experience preferred. Experience in rehabilitation services industry, vocational/occupational/industrial nursing preferred. Background in provincial workers’ compensation law and practices desirable. Excellent interpersonal skills and phone manners. Excellent organizational skills. Ability to set priorities. Ability to work independently. Computer literacy requir

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