Nurse Case Manager – Telephonic
MDD Forensic Accountants
Team Lead, Telephonic Nurse Case Manager
MDD Forensic Accountants
full-time
Posted on:
Origin: • 🇺🇸 United States • Florida
Visit company websiteSalary
💰 $78,000 - $80,000 per year
Job Level
Senior
About the role
- Lead and support the Telephonic Nurse Case Management (TNCM) team, ensuring smooth coordination and communication.
- Act as a preceptor for training new TNCMs; provide coaching and retraining to maintain quality and productivity.
- Assist the Supervisor with daily administrative tasks, including staffing notifications, facilitating team meetings, and supporting workflow management (diaries, emails, etc.).
- Review MCC letters, pre-certifications, and periodic case reviews (30/60/90 days); address compliance issues with TNCM diaries.
- Provide coverage and support during staff absences; report incidents or changes involving staff, providers, networks, or clients.
- Assist with IT issues and submit support tickets when needed; remind staff of meetings and CEU requirements.
- Participate in claim reviews and other meetings as requested; conduct monthly audits and report findings to the Supervisor.
- Participate in interviews and offer input on performance evaluations; train claims staff on identifying case management opportunities.
- Deliver telephonic case management services focused on medical appropriateness and cost-effective care.
- Coordinate communication among injured workers, clients, healthcare providers, and authorized consultants.
- Conduct clinical evaluations and develop individualized recovery plans; identify and address barriers to recovery and revise care plans as needed.
- Monitor medical records and provider performance for quality and compliance; document all case-related information accurately in the claims system.
- Facilitate return-to-work planning and verify disability status using approved guidelines; ensure adherence to treatment protocols, utilization criteria, and account-specific requirements.
- Evaluate treatment outcomes and adjust plans to improve recovery and satisfaction; utilize utilization review tools to identify and resolve recovery barriers.
- Educate injured workers and families on recovery plans and encourage active participation; review medical bills for relatedness.
- Maintain confidentiality and comply with all legal and regulatory standards; advocate for patients while upholding ethical and accreditation standards.
- Negotiate provider fees or redirect cases to appropriate vendors when necessary; meet contracted State of Florida performance standards for case management.
- Provide leadership and guidance to junior staff as needed; perform other duties as assigned.
Requirements
- Minimum of 1 year of Florida Workers’ Compensation case management experience required.
- Demonstrated knowledge of current trends, standards, and regulatory changes in case management and Workers’ Compensation.
- Strong clinical expertise and leadership ability.
- Ability to work independently with minimal supervision; self-directed and proactive.
- Proficiency with personal computers and claims/business software.
- Strong oral and written communication skills.
- Excellent customer service skills; dependable team player with consistent attendance.
- Skilled in performing team lead functions efficiently and respectfully, supporting the Supervisor and fostering a positive team culture aligned with company values.
