Requisition ID |
2025-11503
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# of Openings |
1
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Category |
Professionals
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Location
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US-GA-Lawrenceville
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Overview
The Planner works autonomously to develop any and/or all of the following: Life Care Plans, Medical Cost Projections, Limited Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and/or certifications.
Responsibilities
Collects, reviews and analyzes health data from medical records and/or other sources as provided.
- Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.
- Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed.
- Maintain a quality work product evidenced by acceptable quality scores/score cards.
- Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.
- Attend all scheduled conference calls as mandated by management.
- Maintain any required credentials and adhere to all codes of ethics required by these credentials.
- Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.
- Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines.
- Promote effective and efficient utilization of company resources.
- Participate in various educational and or training activities as required.
- Perform professional duties as assigned by the Manager or upper management.
Qualifications
- Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations.
- Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
- Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
- Ability to demonstrate critical thinking and problem solving skills.
- 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.
- Ability to concentrate and multitask in a fast paced work environment.
- Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
- Must be able to maintain confidentiality.
- Must be able to demonstrate and promote a positive team -oriented environment.
- Must be able to work well under pressure and/or stressful conditions.
- Must possess the ability to manage change, delays, or unexpected events appropriately.
- Must be able/willing to work on a flexible schedule when needs arise.
- Must possess excellent skills in English usage, grammar, punctuation and style.
- Demonstrates reliability and abides by the company attendance policy.
Education and/or Experience Minimum of an Associates degree or equivalent certification preferred. A minimum of one years workers' compensation and/or case management experience preferred. A minimum of one year experience in Medicare Set Asides required. Certificates, Licenses, Registrations Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Active unrestricted Adjuster license. Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting
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