Injury Management - Career Opportunies

Medical Administrator
The Medical Administrator will have direct oversight of Network Telephonic Case Managers (TCM), medical triage and processes and outcomes as it relates to the medical management of a network claim. Works closely with the network system analyst to ensure measure of results, performance of providers, network results and TDI compliance request. The Medical Administrator will be responsible for the Quality Improvement Programs (QIP) while being proactive and facilitates QIP Medical involvement, solutions and proactive measurements. For example, works closely with Case Managers to develop and implement system enhancements relating to medical process, outcomes, etc. Completes timely Provider Relations and/or dispute resolution as it relates to medical and/or case reviews. Supervises network staff related to nurse triage, medical reviews, medical and provider relations. Must hold an RN, CCM or equivalent, preferable business emphasis. Will also consider a Masters in Medical Administration. Must have knowledge of Worker's Compensation, application of clinical criteria to monitor appropriateness of care, level of care, and document findings based on standards and evidenced base guidelines. Prefer experience in health care networks.

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UR Intake Coordinator
Processes incoming requests for pre-authorization from health care providers or injured employees. Collects clinical data to support the request in order to forward the file for nurse review. Compiles, processes and maintains medical records of injured employees in a manner consistent with medical, administrative, ethical, legal and regulatory requirement of the health care system. Requires knowledge in ICD-9 and CPT coding. Relies on instruction and pre-established guidelines to perform the functions of the job. Familiar with standard concepts, practices, and procedures within the medical field. Familiar with Division of Workers Compensation and the Texas Law regarding workers compensation. Relies on limited experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under general supervision.

UR Nurse
Reviews medical treatment records of patient’s with a work related injury to make a determination on medical necessity for services requiring pre-authorization. Process requests for a pre-authorization determination from health care providers or injured employees. Reviews clinical data to determine if the request can be approved as medically necessary. Utilized standard evidence based practice guidelines and best treatment practices. Compiles, processes and maintains medical records of injured employees in a manner consistent with medical, administrative, ethical, legal and regulatory requirement of the health care system. Familiar with standard concepts, practices, and procedures within the medical field. Requires knowledge in ICD-9 and CPT coding. Requires a license to practice nursing in the state of Texas. Relies on instruction and pre-established guidelines to perform the functions of the job. Familiar with Division of Workers Compensation and the Texas Law regarding workers compensation. Relies on clinical nursing judgment to plan and accomplish goals. Experience in orthopedic nursing and workers compensation. Requires a RN or LVN License. Performs a variety of tasks and willing to work on other tasks as assigned. Able to work independently while under general supervision.

Medical Bill Review
Prepares and compiles medical provider bill data for WC clients. Staff must operate a calculator, computer and ten-key. Has knowledge of CPT, ICD-9 and HCPC codes along with commonly used concepts and practices in WC medical bill review. Relies on instruction and pre-established guidelines to perform the functions of the job. Requires a high school diploma or its equivalent and 2-4 years of work experience. Primary job functions do not require exercising independent judgment. Typically reports to a supervisor or manager.

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