CASE MANAGEMENT COORDINATOR - 64567

Executive Service

This is currently a hybrid position (Alternate Work Solutions-AWS is a non-guaranteed privilege and is subject to change at any time), requiring working in the Nashville office a minimum of two days per week. The number of in-office days depends in part on the ability to physically deliver approved registration checks and other fees to the appropriate person in the exemption registry for depositing within the bureau and state auditing timelines.

For more information, visit the link below:
https://acrobat.adobe.com/id/urn:aaid:sc:VA6C2:1ba1558f-7200-48f8-8401-e4c2029c042d

Who we are and what we do:

The Bureau of Workers' Compensation oversees the administration of the state mandated system of benefits to individuals, injured while working, including medical treatment. The Bureau works to assure that the injured workers are getting the medically appropriate and necessary treatment for their injuries in a timely manner.

How you make a difference in this role:

This position coordinates the role of Case Managers, assigned by the insurers or employers, to facilitate the delivery of health care services to the injured worker and the injured worker's understanding of, and adherence to the physician's plan. The Bureau makes every effort to assure the Case Managers are properly trained and carry out their role according to national and Tennessee standards.

Job Overview:

The Case Management Coordinator position is in Nashville, Tennessee. The Case Management Coordinator will educate medical case managers regarding the case management rules, assist case managers and assistants with implementing the rules, and monitor compliance. Case Management helps coordinate the medical treatment to employees for their work-related injuries. A Case Manager can assist in obtaining medical treatment, assuring compliance with medical providers instructions and seeks out the most cost-effective treatment without compromising the patient's quality of care.

Key Responsibilities:

Process registrations, registration renewals, and updated credentials for case managers and case manager assistants in WCS and the access tracker.

Send renewal reminders monthly.

Process case management assistant exceptions and fee waivers when applicable.

Follow up on any registration/renewal fees that have not been received within 30 days.

Process registration and other fees in accordance with state and bureau auditing policies and timelines.

Maintain the email database of all the case managers and case manager assistants up to date.

Verify and update the WCS master listing for the medical provider registry and the hospital listing when a case manager or UR nurse is unable to complete a closure form.

Investigate complaints from parties against case managers. Report findings and discuss resolution with Medical Director or his designee.

Accept and investigate questions and concerns about notification and closure form submissions through the E-portal system and be able to provide troubleshooting.

On an annual basis, review the notification and closure forms for case management and revise as needed.

On an annual basis, review the internal CM policies and procedures and revise as needed in coordination with the medical services coordinator and the medical director. Include an annual review of the CM rules/statutes.

Be able to back up the Utilization Review appeal process.

Be involved in the education and implementation of vocational recovery initiatives and programs.

Assist with the testing and roll out of the new CM/UR-TNComp process and portal.

Work with IT on any portal related issues.

Assist with the case management presentation for the annual conference.

Arrange for the appropriate number of continuing education credits.

Present to outside organizations concerning case management as appropriate.

Be the primary contact for information and education concerning any new medical case management rules, policies, or statutes.

Minimum Qualifications:

Graduation from an accredited college or university with a bachelor's degree and experience equivalent to four years of full-time work in one or a combination of the following: administering insurance or workers' compensation claims; advising or representing clients through legal arbitration; or providing medical case management, occupational health, or vocational rehabilitation services for clients. Substitution of Experience for Education: Additional experience administering insurance or workers' compensation claims; advising or representing clients through legal arbitration; and/or providing medical case management, occupational health, or vocational rehabilitation services for clients' experience, may be substituted for the required education on a year-for-year basis.

Required Experience:

This position requires experience equivalent to four years of full-time work in one or a combination of the following: administering insurance or workers' compensation claims; advising or representing clients through legal arbitration; or providing medical case management, occupational health, or vocational rehabilitation services for clients.

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.