• Work with those injured in the workforce (either physically or psychologically)
• Supporting them and employers through the claims process
• Build and maintain relationships with a wide variety of stakeholder such as, injured workers, their employers and doctors, nurses, rehab providers, etc. 
• Help the injured worker back to work as quickly and safely 
• Be supported by a Team Leader, Technical Specialist and Injury Management Specialists 
• Develop and implement a plan to assist the injured workers’ return to work journey
• Develop well-written commercial payer prior authorization and appeal packages
• Support medical necessity and address payer objections within the guidelines using clinical information and studies/research available  
• Review denied prior authorizations and appeals to determine when and if appropriate to continue efforts 
• Educate payer clinical review staff and/or medical directors about lymphedema and the treatment provided by company products 

Skills: Claims Management, Stakeholder Relations, Rehabilitation Coordination, Injury Management, Medical Documentation, Appeals Handling, Healthcare Advocacy, Team Collaboration

• Coordinate efforts with case management staff to identify and track patients with special/complex needs 
• Make certain all needed services are obtained and barriers to receiving services are removed.
• Assesses eligible patient population for referral, discharge planning and community resource needs and coordinates care with members and providers.
• Review hospital census for discharges that meet diagnosis focused criteria for Transition to Home program.
• Promotes alternative care programs and researches available options including costs and appropriate placement in collaboration with health plan members and physicians.
• Serves as a resource for Health Plan processes and benefits information. 
• Collaborating with team, patients, clinicians, payers and field representatives to overcome payer challenges  
• Develop and foster a strong and effective relationship with key payer personnel 
• Identify beneficial contracting opportunities for whom in-network status contributes to positive revenue growth and alert the Contracting Department of these opportunities 

Skills: Case Coordination, Service Facilitation, Care Assessment, Discharge Planning, Alternative Care Promotion, Resource Expertise, Payer Collaboration, Contracting Strategy

• Schedule and conduct orientation sessions, informing potential and/or referred students of their responsibilities and rights 
• Conduct assessment and develop an education & training plan for each student.
• Work closely with the local Workforce Services Division (WSD) of Will County office staff. 
• Provide updates, attendance, employment information/reports
• Maintain positive working relationships with WSD staff.
• Conduct follow-up, monitor and approve student participation in required activities and hours
• Recommend and/or take actions in compliance with program requirements.
• Maintain case files for each client, prepare weekly and monthly reports and required forms for review and approval. 
• Submit weekly activity reports for each student to the WSD office.
• Recommend and issue wrap around services (such as transportation and childcare assistance) 

Skills: Orientation Management, Educational Planning, Local Agency Collaboration, Data Reporting, Relationship Management, Program Compliance, Case File Maintenance, Support Services Coordination

• Providing accurate and complete information that is consistent and easy to understand including options about claim entitlements, obligations and responsibilities.
• Undertaking ongoing entitlement reviews in relation to weekly payments and medical expenses.
• Collaborating with Injury Management Specialists and Technical Specialists and other technical and support experts.
• Assisting the worker and employer with the claim process and provide support in the completion of relevant documents
• Ensure timely access to required services to support return to work and injury recovery.
• Facilitating active participation of the injured worker and their employer in any return to work and recovery planning.
• Ensuring case management is in accordance with legislation and compliance guidelines.
• Proactively proceeding with appropriate case management to achieve the optimum outcome of early sustainable return to work for workers, with reasonable claim costs.
• Identifying and contributing to processes and practices for continuous improvement opportunities.
• Acting as point of guidance to the Claims Officers when dealing with complex cases.

Skills: Claims Communication, Entitlement Reviews, Cross-functional Collaboration, Claims Support, Service Coordination, Recovery Facilitation, Legislative Compliance, Continuous Improvement

• Conduct reviews of Short Term and Long Term Disability claim files to gather data as required for each project
• Identify claims with opportunities to achieve resolution through enhanced case management
• Develop, implement and monitor disability case management plans in keeping with the company’s case management philosophy and case management best practices
• Provide feedback and coaching to Disability Management Service Office staff regarding ways to enhance their case management plans
• Lead claim review projects, including the development of project worksheets, data collection, data analysis, reporting, and file tracking
• Partner with Head Office departments, such as Benefit Policy and Best Practice and Training
• Identify ways to improve case management and develop any necessary training and supporting documents.
• Commitment to actively live values of Excellence, Partnership, Integrity and Continuous Improvement
• Provide workshops, resources and/or referral to service providers.

Skills: Claims Data Analysis, Resolution Identification, Disability Case Management, Staff Development, Project Leadership, Interdepartmental Collaboration, Process Improvement, Educational Workshops

• Prepare Connect to Future students with all aspects of implementing a successful job search including resume writing, interviewing, and job-search techniques and strategies.
• Attend and participate in WSD staffing and local monitoring visits. 
• Engage in student advocacy, follow-up, crisis intervention and subsequent referral to community organizations and agencies as appropriate.
• Provide quality services and work cooperatively with other service providers and College personnel.
• Maintain high degree of discretion when dealing with confidential information.
• Educate patients and clinicians regarding payer criteria. 
• Direct questions and inquiries in a manner that allows for all necessary information to be gathered with minimal inconvenience to all  
• Maintain compliance with all appropriate regulatory requirements including HIPAA 

Skills: Job Search Coaching, Team Collaboration, Student Advocacy, Service Coordination, Confidentiality Management, Payer Education, Inquiry Handling, Regulatory Compliance

• Current, active, unrestrictive license to practice as Registered Nurse (RN) 
• Clinical nursing experience in an acute care setting.
• Previous discharge planning or case management experience.
• Evidence of ability to handle distressing situations with sensitivity and empathy.
• Evidence of being able to communicate both verbally and in writing at all levels in a multidisciplinary forum and with service users and carers
• Ability to identify High-risk service users and use available resources to reduce risk
• Understanding of clinical governance/risk management frameworks.
• Understanding of assessment and risk management in relation to falls prevention
• Flexibility and ability to work over seven days/on call
• Courage to explore new ways of working and readily adapt to change

Qualifications: BA in Social Work with 3 years of Experience

• Experience or exposure to personal injury and or case management
• High attention to detail and organizational skills
• Effective communication and conflict resolution skills
• Good written and spoken communication skills
• Proficient in Microsoft Excel and PowerPoint 
• Experience/certification in health insurance and managed care programs
• Experience in Medicare and managed care denial management
• Completion of a medical terminology course through a college or technical institution
• Related billing and clinical coding coursework 
• Experience in a hospital setting which includes three years with hospital billing office and admitting experience 

Qualifications: BA in Sociology with 2 years of Experience

• Perform data entry in a timely and accurate manner
• Handle confidential work with discretion
• Exercise good judgment in interpreting and applying rules or policy
• Establish and maintain professional and productive working relationships with others
• Adapt and adjust to a variety of process changes
• Be flexible as the focus on specific tasks will vary daily based on operational needs of the office
• Participate in continuous improvement activities
• Administrative experience in an office atmosphere including preparing and maintaining reports, data entry and customer service experience.
• Knowledge of data collection techniques and methods of analyzing and reporting data.

Qualifications: BA in Psychology with 5 years of Experience

• Retail working experience in FMCG or rapid expansion chain store.
• Can work independently with minimum supervision, and continuously push for improvement.
• Highly developed analytical, critical thinking, and problem-solving skills.
• Have the ability to organize and manage multiple priorities and goals with tight deadlines.
• Aggressive, accountable, and good time management.
• Requires critical thinking skills, ability to make good decisions, listen and accept advice from others
• Demonstrate maturity and good judgment and the ability to work with minimal supervision.
• Communicate effectively with patients, physicians, visitors, insurance companies and providers.
• Ability to monitor and consistently meet deadlines.
• Complies with mandatory, regulatory and credentialing requirements.
• Experience with using everyday computer electronic technology tools
• Experience care nursing experience with a thorough understanding of the discharge planning process 

Qualifications: BS in Nursing with 7 years of Experience

• Supervise and lead a project team whose work concerns highly technical and complex student financial assistance programs.
• Experience analyzing and evaluating methods and techniques applicable to institutional compliance oversight reviews.
• Evaluate the managerial practices of institutions and their services, select appropriate analytical techniques, and develop viable and appropriate recommendations.
• Experience implementing a program to monitor and improve institutional compliance with Title IV legislation, regulations, and policies.
• Experience with analytical methods and techniques applicable to large institutional compliance oversight reviews the administration of the Federal Title IV Student Financial Assistance Programs.
• Experience that includes planning and directing the day-to-day work of a team, ensuring timely and quality work performance, and identifying and implementing ways to improve efficiency and effectiveness.
• Knowledge and understanding of the statutes, laws, and regulations governing the Federal Title IV student aid programs and the requirements for participating post-secondary institutions.
• Ability to plan, organize, and coordinate work and assignments within established time frames and handle emergent requirements in a timely manner.
• Ability to inspire, motivate and guide staff toward accomplishments, goals, and desired outcomes while empowering staff.
• Ability to make clear and convincing oral or written presentations expressing ideas and facts to individuals or groups using correct grammar and verbiage appropriate to the topic and audience.

Qualifications: BS in Public Health with 8 years of Experience

• Experience direct patient care or health education in an inpatient, skilled nursing, home health or related setting. 
• Working knowledge of medical terminology.
• General knowledge of illnesses, current treatments and their physical and psychosocial sequelae.
• Knowledge of alternate levels of care including criteria required for payment and applications processes.
• Experience coordinating benefits and reviewing alternatives with patients and families.
• Experience drafting and issuing denial letters per regulatory and HMO guidelines.
• Knowledge of applicable laws and regulations, government and insurance benefits, especially Medicare, Medi-Cal.
• Knowledge of patient transportation criteria.
• Knowledge of available health care and community resources appropriate for populations served.
• Knowledge of individual and family development over the life span and the influence of cultural and spiritual values in health care.

Qualifications: BS in Counseling with 5 years of Experience