Medical Case Manager I
$63,739–$95,264 year
On-sitePittsburgh, Pennsylvania, United States
Job Summary
Conduct in-person and telephonic medical case management for injured workers, coordinating with patients, physicians, and providers to facilitate recovery. Perform initial home evaluations, attend medical and attorney visits, and lead discharge planning conferences to determine appropriate long-term care strategies. Assess treatment plans for medical necessity and cost-effectiveness while negotiating durable medical equipment and nursing services. This role requires local travel up to 60% of the work week, including occasional overnight trips, with a 2-hour radius for appointments. Candidates must hold an active RN license and possess strong communication skills to manage high-volume caseloads effectively.
Required Qualifications
- Registered nurse (RN)
- Current RN Licensure in state of operation
- Valid driver's license
- Reliable transportation
- Ability to travel to assigned locations
- Ability to travel up to approximately 60% of the work week/month
- Ability to work both independently and within a team environment
- Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets
- Ability to meet with the patient, their physicians, other healthcare providers, attorneys, advisors/clients, and coworkers
- Strong interpersonal, time management, and organizational skills
- Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment
Desired Qualifications
- Experience as an RN Medical Case Manager
- Clinical background in orthopedics, neurology, or rehabilitation
- Certification as a CCM, CIRS, or other Case Management certifications
- A cost containment background, such as utilization review or managed care
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