Case Managers MD, VA, PA
M Hayes is a national managed care company
These positions will report directly to the Regional Manager. We offer a very competitive salary and benefits package!
RESPONSIBILITIES AND ESSENTIAL ACTIVITIES:
The Medical Services Consultant is responsible for providing case management services which facilitate the delivery of quality, cost effective interventions to injured and ill clients across the continuum of care. The Medical Services Consultant collaborates with the client, payer, medical providers and other resources to achieve the recovery and autonomy of the client through advocacy, assessment, planning, communication, education, resource management, and service coordination/ implementation.
The following responsibilities and activities are involved in the case management process throughout the continuum of care.
REFERRAL:
Identifies clients appropriate for assessment.
EVALUATION/ASSESSMENT:
Develop rapport with the client, medical providers, employer, payer, legal representatives, and all other appropriate parties, and foster understanding of the purpose and goals of the case management process.
Collect and document information about the client's circumstances, functioning, and needs in order to identify, goals and objectives, necessary to develop a comprehensive case management plan.
Gather information by interview with the client, and other relevant sources such as, family members, primary and other treating providers, employers, payers and through the review of medical records.
Utilize industry recognized decision support tools for disability duration and treatment protocol. Establish goals through use of the benchmarks in managing medical treatment and disability duration. Evaluate outcomes regarding actual RTW performance and treatment in comparison to benchmarks and calculates savings accordingly.
Establish ongoing relationships and communication with all parties to ensure that all new information impacting the client being served by the case management process is evaluated.
PLAN DEVELOPMENT:
Critically assess and integrate all relevant information necessary to develop an effective case management plan.
Identify objectives, goals, and actions to specifically address and meet the needs of the client being served by the case management process, through interdisciplinary collaboration.
IMPLEMENTATION:
Identify, procure, provide, and coordinate services and resources necessary to execute case management plan actions.
Communicate and interact with client, medical providers, employer, payer and other appropriate parties to accomplish the agreed upon objectives set forth in the case management plan.
Evaluate new information, identify barriers and implement solutions to ensure successful, timely and cost effective outcomes.
COORDINATION:
Coordinate quality, cost effective, and necessary medical treatment and services as needed to support the objectives of the case management plan. Such services may include, therapy, durable medical equipment, home care, and discharge planning.
Consult with treating providers on a regular basis, and facilitate additional evaluation services where prescribed.
Develop early return to work alternatives through interaction with the client, employer, and medical provider, where consistent with the plan objectives.
Communicate with the client on a regular basis to address ongoing health, medical, psychosocial needs in order to provide or coordinate needed services/interventions.
MONITORING/ONGOING EVALUATION:
Monitor activities and services associated with the case management process on an ongoing basis.
Provide regular and consistent communication with the client, medical provider, payer, employer, and all appropriate parties to gather information necessary to critically evaluate the progress and effectiveness of the case management plan.
Apply negotiation and conflict resolution strategies to overcome barriers to plan.
Identify, provide/coordinate services necessary to ensure effectiveness of plan.
Modify plan actions where necessary to account for changes in the client's condition, treatment, or other relevant circumstances.
Communicate plan changes to all appropriate parties, and foster understanding and agreement among all parties.
REPORT WRITING/RECORD KEEPING:
An Initial Assessment report must be completed within a reasonable timeframe from referral, generally, 15 days.
Status or interim reports are to be completed on a minimum of 30 day basis, depending on case acuity as well as account directives.
Closure reports are to be completed when assignment goals have been accomplished and services are no longer necessary.
CLOSURE:
Case closure is affected when case management goals have been achieved or further services will not result in a benefit or individual's improvement.
EDUCATION/LICENSURE AND CERTIFICATIONS:
Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline and 2 years full-time equivalent of direct clinical care to the consumer and at least one of the following:
• Certification as a Case Manager, from the URAC approved list of certifications (A-CCC, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, RN,C, RN,BC); or
• A bachelor's (or higher) degree in a health or human services related field; or
• A Registered Nursing (RN) license
Maintains case management and other specified professional certifications and certifications and registrations as required by respective states, regulations and statures.
PROFESSIONAL EXPERIENCE/COMPETENCY QUALIFICATIONS:
A broad range of knowledge of medical diagnosis/impairments is desirable; preferably rehabilitation, trauma, or occupational experience. Bilingual preferred, but not required.
Send resumes to jobs@mhayes.com
