Medical Case Manager, Utilization Review - TRISTAR Insurance Group, Inc (las vegas, nevada) in Las Vegas, Nevada For Sale

The medical case manager coordinates resources and cost effective options on a case:by case basis to facilitate quality individualized treatment goals and return to work placement. This position calls for providing medical case management to individuals through coordination with the patient, physician, claims examiner and employer. The medical case manager must possess excellent communication and organizational skills to interface with the client and claimants and be able to work well independently.ESSENTIAL DUTIES AND RESPONSIBILITIES: Possess excellent communication and organizational skills to interface with the client and claimants and staff. Work well independently. Primary responsibilities include:Clinical operations across the continuum of care to include assessing, planning, implementing, coordinating, monitoring and evaluating health care deliverySetting team direction, resolving problems and providing guidance to members of the teamEnsures that the team meets established performance metrics and performance guaranteesAdapts departmental plans and priorities to address business and operational challengesTaking a lead role in developing and participating in new programsCase management and coordination of care for injured workersQUALIFICATIONS REQUIRED:Current, unrestricted RN licenseMinimum of 3 years of clinical experienceDemonstrated experience driving operational performance and achieving established metricsDemonstrated experience developing workflows or implementing process improvements to gain operational efficienciesExcellent communication skills with the ability to interrelate with individuals at various levels and in various functional areas throughout the organizationProficient in Microsoft Word and Excel Additional Assets Preferred:2+ years of WorkersA? Compensation experience2+ years of Case Management Telephonic and/ or Field Case Management2+ years of prior management/supervisory experienceUndergraduate degree or equivalent experienceAbility to develop effective business relationships across business and product teams Knowledge, Skills and Abilities:Strong clinical background in Orthopedics, Rehabilitation and case management.Strong cost containment background. Good clinical thinking and professional documentation. Other Qualifications: BSN desirable. Certification in CPDM or CCM, CPHM , preferred.Other Qualifications: BSN desirable. Certification in CPDM or CCM, CPHM , preferred.
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