Nursing - Case Manager

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Provides telephonic case management for workers compensation cases involving lost time and extensive medical care. Acts as a liaison between claimants, providers, external claim representatives, clients and attorneys, as needed, to manage the appropriate level of care.

Performs selected medical appropriateness protocol procedure activities including telephone interviews and collection of information from claimants, providers and the client. Performs three-point contact, directs care into the network, follows up on status of treatment, corresponds with providers and documents the file consistently. Evaluates and coordinates the treatment plans proposed by providers, in accordance with established HCS protocols. Authorizes medical treatment and associated diagnostic testing on assigned claims. Acts as liaison with client to identify issues and problems relating to medical care, treatment plans, and claim processing and forwards concerns appropriate parties, when necessary. Initiates calls and correspondence to claimants, providers, and the client to coordinate courses of treatment. Reviews and identifies claims involving complex injuries/treatment plans and refers them to a nurse case manager.