<ul><li><strong><em>This is a full-time position for one our clients!</em></strong></li><li><strong><em>MUST live in NYS.</em></strong></li><li><strong><em>Salary and excellent benefits package!</em></strong></li></ul><p><br></p><p><strong><em>Senior Patient Advocate: HYBRID OR REMOTE IN NYS. Albany, NY ideal but flexible! </em></strong></p><p><br></p><p>The Senior Patient Advocate demonstrates knowledge, skills, and competency in the application of case management standards of practice. They are an integral part of the claims’ team and work to ensure that appropriate treatment and return-to-work plans are established and implemented on work-related injuries/illness claims.</p><p><br></p><p>The Senior Patient Advocate also functions as a resource to claims staff and Patient Advocates. They are actively involved in training and team building and are a strong advocate of the claim management team, assisting in the implementation of all claim organization initiatives. Assists in the development of case management policy and procedure and participates in the promotion of workplace wellness throughout the company membership.</p><p><br></p><p><strong>Essential Job Functions:</strong></p><ul><li>Assume leadership role, complying with and assisting management in the administration of organization processes. Assist in the implementation of new processes and makes suggestions for and contributes to improvements.</li><li>The Senior Patient Advocate will produce work of the highest quality. All files assigned will demonstrate quality case management which includes appropriate assessment, planning, implementing, coordinating, monitoring, and evaluating the services and resources necessary to respond to the claimant’s needs.</li><li>Prioritizes caseload so that all cases receive the proper claim handling and are brought to prompt resolution.</li><li>Actively looks for opportunities to mitigate medical costs and improve claims outcomes. Documents impact on all files.</li><li>Adheres to all applicable legal and regulatory standards.</li><li>Remain current on medical and legal topics needed to provide case management for workers’ compensation claims.</li><li>Promotes a transitional duty program for all membership.</li><li>Addresses return to work capability with the injured worker, provider, employer, and all associated parties.</li><li>Calculates and monitors the estimated length of disability according to published criteria throughout the life of the claim.</li><li>Assesses medical documentation and provides interpretation to staff as well as treatment practices that exceed the NYS Medical Treatment Guidelines and takes appropriate action as indicated. Assists as necessary to assure the adherence to procedures and service standards.</li><li>Provides medical claims management recommendations to the Case Analyst and management.</li><li>Effectively communicates with the Case Analyst in formulating and individualizing the medical component of the claim.</li><li>Completes medical cost reviews as requested to assist the claims team in setting accurate medical reserves.</li><li>Assists the Case Analyst in file preparation for settlement and/or litigation as needed.</li><li>Negotiates services and medical equipment when necessary to obtain quality, cost effective outcomes.</li><li>Provides and/or coordinates in-service education to the claims staff.</li><li>Initiates and/or Responds to all associated Member Interactions and Alerts per service team standards.</li><li>Participates in claim reviews and member orientation/reorientation meetings.</li><li>Uses the claim system, Origami, to manage and maintain claim files.</li></ul><p><br></p><p><strong>REQUIREMENTS:</strong></p><p><strong><u>MUSTS:</u></strong></p><ul><li>Licensed Registered Nurse in the applicable state.</li><li>Workers comp/workers’ compensation</li><li>Strong clinical background required.</li></ul><p><br></p><p><strong><u>Preferred:</u></strong></p><p>Critical care experience preferred, and Occupational Health experience preferred.</p><p>A minimum of 5 years of Case Management experience preferred.</p><p><br></p><p><strong><u>And can get the certification within 2 years: </u></strong></p><p>National certification in Case Management is mandatory (such as CCM, COHN, AAOHN CM cert., CIRS, CRC, etc.). Case management experience in the insurance field preferred.</p><p><strong><u>CCM will need to be obtained within 2 years of hire.</u></strong></p><p><br></p><p><strong>****Open to some travel, less than 20% in NYS. Do not have to have a car but need to have a NYS driver's license.</strong></p><p><br></p><p><br></p>