Clinical Case Manager

Clinical Case Manager

LCG LewisCo Group is on the hunt for Clinical Case Managers to examine Disability Pension and FMLA, STD, and/or LTD claims from a medical and contractual standpoint and serve as a medical resource and consultant to case managers to assess functionality based on medical evidence. Our consultants will review and evaluate disability claims to determine the level of functioning based on knowledge of current medical standards of care and employer job requirements. To be qualified for this role, prospective candidates will need heavy medical expertise obtained through current licenses, registrations and/or professional designations required with the Deerfield jurisdiction. Our team is looking for registered nurses with five years of experience in the clinical cases areas of nursing or occupational health. Essential Job Functions Review and evaluate disability claims to determine level of functioning based on knowledge of current medical standards of care and knowledge of the employer and the employees job requirements, as well as the plans definition of disability. Resolve inconsistencies in the level of functioning. Coordinate a strategy to determine true level of functionality. Review claims from a medical perspective to determine if medical evidence supports disability based on contractual provisions. Document disability status and assessment to include medical, contractual, and vocational information. Triage disability claims into appropriate claim management tracks (system-generated changes made during clinical case review). Act as medical consultant to Appeals Unit. Coordinate and monitor quality of IMEs and FCEs. Coordinate internal physician consultant referrals by using supporting clinical resources and vocational resources. Identify barriers for employees to return to work as well as identifying appropriate (optimal) health care, rehabilitation and work to facilitate an early and safe return to work. Communicate effectively with employers, employees, and health care providers. Manage daily relations with assigned accounts and key contacts. Upon account requirements and upper management request, visit clients for new account implementation and maintenance of existing accounts. Seek and maintain current profession credentials, and engage in continuous medical educationQualifications Extensive medical knowledge. Strong investigative and analytical skills. Strong customer service skills. Strong written and oral communication skills. Strong organizational and time management skills. Ability to assess medical records. Work in team environment. Education and Experience Requirements Must hold current licenses, registrations, and/or professional designations required within the jurisdiction. Five years of experience in clinical care areas of nursing or occupational health. Be a registered nurse. Desired Experience but Not Required 2-3 years of disability case review or case management experience. CCM, CDMS, and COHN designations. Behavioral health and physical health background combination.