Medical Case Manager
Company: AmTrust Financial Services, Inc.
Posted on: June 7, 2021
The Medical Case Manager provides comprehensive quality
telephonic case management to proactively drive a medically
appropriate return to work through engagement with the injured
employee, provider, and employer. The Medical Case Manager is
empathetic, informative, and collaborative. This position
coordinates medical resources for our injured employees and
partners with the AmTrust Claims Adjuster team to develop a
personalized holistic approach for each claim. Maintains a solid
understanding of AmTrust's mission, vision, and values. Upholds the
standards of the AmTrust organization.
- Uses clinical/nursing skills to determine whether all aspects
of a patient's care, at every level, are medically necessary and
- Perform Utilization Review activities prospectively,
concurrently, or retrospectively in accordance with the appropriate
- Sends letters as needed to prescribing physician(s) and refers
to physician advisor as necessary
- Responsible for accurate comprehensive documentation of case
management activities in case management system.
- Uses clinical/nursing skills to help coordinate the
individual's treatment program while maximizing quality and
cost-effectiveness of care including direction of care to preferred
provider networks where applicable.
- Addresses need for job description and appropriately discusses
with employer, injured employee and/or provider. Works with
employers on modifications to job duties based on medical
limitations and the employee's functional assessment.
- Responsible for helping to ensure injured employees receive
appropriate level and intensity of care through use of medical and
disability duration guidelines, directly related to the compensable
injury and/or assist adjusters in managing medical treatment to
- Communicates effectively with claims adjuster, client, vendor,
supervisor, and other parties as needed to coordinate appropriate
medical care and return to work.
- Performs clinical assessment via information in
medical/pharmacy reports and case files; assesses client's
situation to include psychosocial needs, cultural implications, and
support systems in place.
- Objectively and critically assesses all information related to
the current treatment plan to identify barriers, clarify, or
determine realistic goals and objectives, and seek potential
- Partners with the adjuster to develop medical resolution
strategies to achieve maximal medical improvement or the
- Evaluate and update treatment and return to work plans within
established protocols throughout the life of the claim.
- Engage specialty resources as needed to achieve optimal
resolution (behavioral health program, physician advisor, peer
reviews, medical director).
- Partner with adjuster to provide input on medical treatment and
recovery time to assist in evaluating appropriate claim
- Keeps current with market trends and demands.
- Performs other functionally related duties as assigned.
- Active unrestricted RN license in a state or territory of the
United States with eligibility to get and/or renew a multistate
- 5+ years of related experience or equivalent combination of
education and experience required to include 2+ years of direct
clinical care OR 2+ years of case management/utilization management
- National Certification in case management OR the ability to
obtain certification within 24 months of employment is
- Bachelor's degree in nursing (BSN) from accredited college or
university or equivalent work experience preferred. Certification
in case management, pharmacy, rehabilitation nursing or a related
specialty is highly preferred.
- Acquisition and maintenance of Insurance License(s) may be
required to comply with state requirements. Preferred for
license(s) to be obtained within three - six months of starting the
- Written and verbal fluency in Spanish referred
- Proficiency in all Microsoft Office products including Project,
Word, Excel, PowerPoint, Visio, and SharePoint
- Knowledge of workers' compensation laws and regulations,
behavioral health, case management practice, URAC standards, ODG,
Utilization review, pharmaceuticals to treat pain, pain management
process, drug rehabilitation, state workers compensation
guidelines, periods of disability, and treatment needed
- Excellent oral and written communication, including
- Leadership/management/motivational skills as well as analytic
and strong organizational skills
- Ability to work in a team environment and to meet or exceed
This job description is designed to provide a general overview
of the requirements of the job and does not entail a comprehensive
listing of all activities, duties, or responsibilities that will be
required in this position. AmTrust has the right to revise this job
description at any time.
What We Offer:
AmTrust Financial Services offers a great work environment,
competitive compensation package and excellent career advancement
opportunities. Our benefits include: Medical and Dental Plans, Life
Insurance, Health Care Flexible Spending, Dependent Care, 401k
Savings Plans, and Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where
thoughts and ideas of all employees are appreciated and respected.
This concept encompasses but is not limited to human differences
with regard to race, ethnicity, gender, sexual orientation,
culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the
diverse backgrounds, skills, and perspectives of its workforce, it
will sustain a competitive advantage and remain an employer of
choice. Diversity is a business imperative, enabling us to attract,
retain and develop the best talent available. We see diversity as
more than just policies and practices. It is an integral part of
who we are as a company, how we operate and how we see our
AmTrust Financial Services is committed to a policy of Equal
Keywords: AmTrust Financial Services, Inc., New Haven , Medical Case Manager, Other , Melville, Connecticut
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