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Case Manager Physical Therapy

Company Name:
CareCore National
Job Description:
Maintain communication with the appropriate Clinical and/or Administrative personnel regarding the day-to-day functions and operations of the department and staff.
Assist in the development of training materials for practitioner, client, and member orientation. Assist in creating and/or revise clinical criteria when needed; assist in the creating of new or revise existing medical policy statements when appropriate.
Serve as an interface with physical or occupational therapy practitioners regarding utilization management requirements and procedures, claims, quality of care, and administrative issues.
Conduct initial clinical review of Treatment Plan (authorization) requests for care and formulate appropriate and consistent clinical review decisions that adhere to Landmark's Clinical Practice Guidelines (clinical review criteria). Appropriately direct any case that does not meet Landmark's Clinical Practice Guidelines for medical physician review.
Support the credentialing and re-credentialing processes for new and existing Landmark practitioners as necessary and appropriate. Assist with the development and implementation of Landmark's Utilization Management and Quality Management activities.
Maintain an active unrestricted license to practice. Employee is required to immediately notify the company of any restrictions or changes in professional licensure.
Attend continuing education classes, seminars, conventions and training sessions to enhance clinical knowledge and/or to strengthen understanding of managed care principles and practices as appropriate. Provide Landmark copies of complete certificates of completion from such continuing education events annually.
Handle confidential information pursuant to all internal Landmark controls and federal and state laws governing such information, including those governed by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is required to use the telephone and the computer. The employee uses arms and hands for data entry and paperwork. The employee may occasionally lift and/or move up to 10 pounds. The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
, External Job Requirements:
Strong written and verbal skills for communication to directors, management, clients, practitioners, patients, staff, board or committee members, and the community regarding conflict resolution, relaying concepts, providing training and/or public speaking when necessary.
Must be in good standing with the State and National Physical Therapy Societies and Associations. Must maintain a continuously active physical therapy license.
Must have no outstanding liability cases or pending problems with the State Physical Therapy Board of Examiners or any other federal or state regulatory agencies.
Working knowledge and experience in personal computer software programs required. Experience in a Microsoft Office environment preferred.
Requisition Number: 668
City: Bluffton
State: South Carolina
Job Title: Case Manager Physical Therapy
Area of Interest: Musculoskeletal

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