Medical & Vocational Case Manager For Workers Compensation
Henrico ,VA
Summary
Accomplished Case Quality Analyst and Field Case Manager with a proven track record of enhancing product quality and streamlining case management processes for Workers Compensation files.
Overview
16
16
years of professional experience
2
2
Certifications
Work History
Field Case Manager
Genex
01.2021 - 10.2024
Managed up to 30 medical and vocational workers compensation files.
Collaborated with interdisciplinary teams to ensure seamless delivery of case management services across various settings.
Streamlined communication between healthcare providers, attorneys, insurance carriers, employers, patients, and families for optimal care coordination.
Identified potential barriers to successful care plan implementation and developed innovative solutions to overcome these challenges.
Monitored patient progress closely, adjusting case management plans as needed to achieve desired outcomes.
Conducted thorough assessments of patient needs, resources, and support systems to inform case management strategies.
Case Quality Analysis
Aetna
05.2018 - 08.2020
Applied case management processes, department processes, and rules and regulations of Workers Compensation in VA, MD, PA, GA, WV, FL, CA, and MI.
Scheduled case management tasks/activities to achieve file goals.
Researched treatment guidelines and if current treatment plan agrees or disagrees with clinical guidelines.
Enhanced product quality by meticulously analyzing and identifying areas for improvement in case management processes.
Developed and maintained comprehensive documentation of all quality analysis activities, ensuring full compliance with industry standards and regulations.
Created and revised procedures, checklists and job aids to reduce errors.
Developed and implemented procedures to meet product quality standards.
Vocational Field Case Manager
Coventry
07.2008 - 04.2017
Developed effective communication strategies to relay information between insurance carriers, employers, injured workers, attorneys and healthcare professionals.
Managed up to 30 caseloads efficiently while adhering to ethical guidelines and maintaining high-quality service standards.
Maintained thorough case documentation, ensuring accurate records and efficient service delivery.
Conducted labor market research to better inform clients of potential career opportunities.
Provided guidance on job-search strategies, resulting in successful employment for numerous clients.
Education
Master Of Science - Rehabilitation And Disability Studies
Springfield College
Springfield, MA
Bachelor Of Arts - Psychology
Louisiana Tech University
Ruston, LA
Skills
Job Analysis
Certification
CRC
Timeline
Field Case Manager
Genex
01.2021 - 10.2024
Case Quality Analysis
Aetna
05.2018 - 08.2020
Vocational Field Case Manager
Coventry
07.2008 - 04.2017
Master Of Science - Rehabilitation And Disability Studies