At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

Experience

• Nursing, case management, or other health care profession experience of at least five to ten years and demonstrated expertise with quality assurance and compliance standards and process, rehabilitation, insurance, managed care, workers compensation and outcomes.

• Prefer previous experience in supervisory and management position.

• Minimum of two years experience in workers compensation case management

• Demonstrated experience and competency in working with individuals and groups.

Education

RN, BSN, CCM preferred, other undergraduate degrees allowing a CCM will be considered.

Maintain active nursing license in home state; Willingness to obtain nursing licenses in other states, as requested

Essential / Major Duties

• Review and oversee case content, documentation, and adherence to special handling instructions and billing guidelines.

• Ensure productivity, efficiency, and effectiveness through pro-active case management.

• Demonstrate successful ability to build positive relationships and partnerships within department, across the organization and with external customers.

• Manage work and performance of contract staff, oversee work produced and provide training and support as needed.

Knowledge, Skills, and Abilities

• Knowledge of Case Management Code of Conduct

• Knowledge of 1099 employment of guidelines

• Knowledge of state statutes and laws regarding workers compensation.

• Knowledge of medical case management program.

• Knowledge of industry standard case management billing practices

• Knowledge of patient rights and commitment to patient advocacy.

• Effective educator skills.

• Excellent written and oral communication skills.

• Ability to understand and interface with claim systems.

• Intermediate proficiency with Google Suite.

• Word processing and data entry skills.

• Demonstrate ability to identify problems and implement a plan of improvement within the constraints of 1099 laws and guidelines.

Job Duties and Responsibilities

• Review vendor files for appropriate documentation and proactive case management

• Monitor documentation and billing of file activity to ensure adherence to industry quality and billing standards.

• Provide ongoing training as identified through file reviews or new account implementation.

• Assist with Carelink Systems training and education after new contract agreement initiated

• Maintain a complaints log noting any action taken

• Assist Senior Manager in Special Projects as requested

KEY PERFORMANCE INDICATORS

Customer Service Satisfaction

Case Management Industry Standards Maintained by 1099 Staff