Medical Policy Manager jobs in Greensboro, NC

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

This is a full-time, work-from-home position. The candidate must be located in the Greensboro, NC area due to regular local travel for in-person patient appointments.

Perks: Full and comprehensive benefits program, 24 days of paid vacation/holidays in your first year plus sick days, home office equipment including laptop and desktop monitor, mileage and travel reimbursement, Employee Assistance and Referral Program, and hands-on workers' compensation case management training.

Join our compassionate team and help make a positive difference in an injured person's life. As a Field Case Manager, you will work closely with treating physicians/providers, employers, customers, legal representatives, and the injured/disabled person to create and implement a treatment plan that returns the injured/disabled person back to work appropriately, ensure appropriate and cost-effective healthcare services, achievement of maximum medical recovery and return to an optimal level of work and functioning. In this role, you will:

• Demonstrate knowledge, skills, and competency in the application of case management standards of practice.
• Use advanced knowledge of types of injury, medications, comorbidities, treatment options, treatment alternatives, and knowledge of job duties to advise on a treatment plan.
• Interview disabled persons to assess overall recovery, including whether injuries or conditions are occupational or non-occupational.
• Collaborate with treating physicians/providers and utilize available resources to help create and implement treatment plans tailored to an individual patient.
• Work with employers and physicians to modify job duties where practical to facilitate early return to work.
• Evaluate and modify case goals based on injured/disabled person's improvement and treatment effectiveness.
• Independently manage workload, including prioritizing cases and deciding how best to manage cases effectively.
• Complete other duties, such as attend injured worker's appointments when appropriate, prepare status updates for submittal to customers, and other duties as assigned.

• Education: Associates Degree or Bachelor's Degree in Nursing or related field.
• Experience: 2 years clinical practice preferred. Workers' compensation-related experience preferred.
• Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills.
• Certifications, Licenses, Registrations:
  • Active Registered Nurse (RN) license required. Must be in good standing.
  • URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC).
  • Valid driver's license and auto insurance required.
• Travel: Must have reliable transportation and be able to travel to and attend in-person appointments with injured workers in assigned geography.
• Internet: Must have reliable internet.

PI239745609