Medical Management Coordinator

Basking Ridge, NJ 07920

Posted: 08/27/2019 Industry: Clerical Job Number: 9104 Pay Rate: $52,000 - $54,000/yr. (DH)

SUMMARY

Responsible position providing medical management services to the Association Claims case management.



RESPONSIBILITES

  • Provide a high level of quality customer service



  • Monitor medical cost control processes and programs



  • Monitor vendor compliance with company requirements, as directed



  • Review files and invoices to evaluate appropriate levels of care and medical payments, as well as quality control of the medical aspects of claims management



  • Review files and invoices to evaluate compliance with applicable statutory and regulatory requirements, as well as industry best practices



  • Other tasks as requested or required including but not limited to:



  • Contacting claimant or attorney to provide information on case management and discuss appointment dates



  • Contacting physician(s) to confirm appointment times, address, etc.



  • Where applicable, contacting employer to discuss work status, determine light duty availability, etc.



  • Creating and sending appointment letters out



  • Requesting and exchanging medical records with the appropriate parties



  • Sending treatment form to be completed by provider and following up on completed report



  • Coordinating treatment recommendations by authorized treating provider with the claim s adjuster



  • Completing Medical Cost Projection and Estimated Length of Disability (consistent with ODG Guidelines) with provider



  • Coordinating approval of medications as prescribed the authorized provider





QUALIFICATIONS

  • Bachelor's degree in nursing, or related field, or the equivalent in work experience



  • Licensed RN or LPN



  • Three to five years of progressively responsible positions in claims



  • Strong verbal and written communication skills



  • Ability to work effectively with staff and constituents



  • High degree of judgment



  • Knowledge of medical management practices and requirements, applicable claim procedures, statutes, compliance, insurance laws and insurance coverage



  • Ability to work independently



  • Strong organizational skills with ability to prioritize effectively and meet deadlines



  • Proficiency in Word and Excel


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