Case Coordinator
IME Resources - Warren, MI

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This position will be based out of Cleveland, OH.

Essential Duties and Responsibilities *
  • Performs quality assurance review of reports, correspondences, addendums or supplemental reviews *
  • Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations *
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed *
  • Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications *
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards *
  • Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report *
  • Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists *
  • Ensures the provider credentials and signature are adhered to the final report *
  • Identifies any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed *
  • Assists in resolution of customer complaints and quality assurance issues as needed *
  • Ensures all federal ERISA and/or state mandates are adhered to at all times *
  • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications *
  • Promote effective and efficient utilization of company resources *
  • Participate in various educational and or training activities as required.

Key Qualifications
High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability *
  • Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values *
  • Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages *
  • Must be a qualified typist with a minimum of 40 W.P.M *
  • Must be able to operate a general computer, fax, copier, scanner, and telephone *
  • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet *
  • Must possess excellent skills in English usage, grammar, punctuation and style *
  • Ability to follow instructions and respond to upper managements' directions accurately *
  • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met *
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed *
  • Must be able to work independently, prioritize work activities and use time efficiently *
  • Must be able to maintain confidentiality *
  • Must be able to demonstrate and promote a positive team -oriented environment *
  • Must be able to stay focused and concentrate under normal or heavy distractions *
  • Must be able to work well under pressure and or stressful conditions *
  • Must possess the ability to manage change, delays, or unexpected events appropriately *
  • Demonstrates reliability and abides by the company attendance policy *
  • Must maintain a professional and clean appearance at all times consistent with company standards *
  • Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and legal contracts and documents *
  • Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar *
  • Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community *
  • Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

IME Resources - 14 months ago - save job - block