Unit Manager, Case Management

Orlando, Florida
Not Specified
Apr 04, 2018
Jun 03, 2018
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

  • The Unit Manager, Case Management brings medical expertise and support of execution, growth and process to the Managed Care program through the triage review of injuries, utilization review, facilitation of return to work and medical case management services. The Unit Manager shall perform a dual function role consisting of managerial duties such as oversight of contracts, referral, reporting, financial accountability, and operation activity in the form of medical case management as defined in detail below.
  • Managerial Function:

    • Job duties center on maintaining the procedural integrity of medical case management service while facilitating the nurse team to adaptation and development with the ever changing medical management environment of workers compensation claims and/or managed care. This includes recruiting and hiring nurses, contracting, training, internal/external marketing, and communicating with multiple departments and offices The scope of responsibility spans beyond California to include national coverage to develop in sync with our claims operation growth
    • Directs and plans the work of staff members and has direct involvement with and/or responsibility for the hiring, coaching, developing, training, appraising and disciplinary processes for subordinates
    • Attend staff meetings

    Medical Case Management:

    • Manages a sustainable caseload of telephonic case management (TCM), task assignment, and limited range-field, case management services. For those cases requiring field case management work that cannot be retained, the support of WellComps staff of 8 field nurses and management will be afforded
    • Complete claims notepads of all medical case management activity in a timely manor with a high level of accuracy and detail
    • Reporting of medical case management activity will be generated no less than every 45 days and will be provided to the Claims Examiner and Employer. Medical case management activity, for the purpose of billing, will be placed in the WorkLink System
    • Perform Quality Review audits

    Sales and Marketing:

    • It is the expectation and responsibility of each manager to participate in sales opportunity (both written and oral presentation) when requested. The Unit Manager, Case Management will continue to seek growth of the business through the RFP process as well as solicitation of referrals for medical case management services
    • Communicate progress as well as challenges to management for immediate correction, assistance, and facilitation of challenges encountered
    • Attend sales meetings
    • Develop an appropriate level of understanding of the Medical Provider Network Program and internal systems (Work Link, Web access, Applications, Word Based Programs, Excel, etc.)
    • Interface with MPN program, Utilization Review and all other internal departments as needed with the goal of successful interaction and coordination of all offered services
    • Interact with clients when needed

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