• Sr. Managed Care Specialist

    Location US-FL-Lakeland
    Posted Date 4 months ago(8/16/2018 3:53 PM)
    Job ID
    23828
    # Positions
    1
    Category
    Claims
    Position Type
    Full Time
    Travel Percentage
    0 to 10%
  • Overview

    Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees.

     

    Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast.

     

    Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

    Responsibilities

    OFFICE BASED TELEPHONIC NURSE CASE MANAGER

     

    • Monitors and facilitates each claimant's medical treatment to ensure appropriate, effective, cost-efficient and quality care.
    • Coordinates with vendors of rehabilitative services to ensure that services are consistent with the diagnosis and the goal of returning the claimant to employability and / or normal activities.
    • Coordinates attendant care supervision, including the selection of appropriate care facilities. Assigns cases to vendors for utilization review.
    • Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures.
    • Provides technical advice to lower level associates and other functional areas.
    • Leads the work of others (mentors, prioritizes, delegates and reviews assignments).
    • Performs other duties as assigned.

     

     

    Qualifications

    • R.N. (Registered Nurse) required; Bachelor's Degree preferred but will consider Associate Degree with relevant experience
    • 6 or more years of Case Management experience.
    • Bill Review experience a plus (CPT/ICD/HCPS Coding and billing guidelines)
    • This is not a work-from-home position: may be located in Lakeland, FL or Gainesville, GA office

     

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