The Medical Management Liaison position reports directly to the Manager, Medical Case Management.  This position provides daily administrative support to professional Registered Nursing staff, increasing production in the areas of Early Intervention, Case Management, and Utilization Review. This position will assist the nursing staff with Case Management (CM) and Utilization Review (UR) clerical duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, the employee must be able to perform efficiently and effectively each of the following essential functions.  Reasonable accommodation may be made for individuals with disabilities.

The functions of this job include but are not limited to:

• Intake, prioritizing and timely processing of new Case Management referrals.
• Monitors, collects, processes, and distributes all types of correspondence accordingly. Reports issues with incoming/outgoing correspondence immediately.
• Enters/uploads reports and clear notes into the CM Software Application System.
• Makes timely pertinent phone calls to obtain medical reports, treatment plan and RTW related information/reports to provide to the Case Management Nursing Staff.
• Transfers any/all calls where there is clinical information being provided (or a clinically related question surfaces) to a registered nurse for response - Licensed staff are always available to assist non-clinical staff while they are attempting to obtain information.
• Schedules Injured Worker appointments, as appropriate and under the direction of clinical staff.
• Types injured worker appointment letters and other pertinent letters as requested by and under the oversight of a registered nurse.
• Maintains ongoing non-clinical communications, collaborates with pertinent parties related to claims that are open to Case Management and to manage the Utilization Review process or for other administrative tasks as needed.
• Process Utilization Review requests: performs data entry functions, reviews multiple criteria to determine eligibility of treatment requests, approves treatment requests based on authority level, refers treatment requests to a clinical resource or sends appropriate response level.
• Coordinates with claim adjusters or nurses to validate claims or clinical information respectively to make decisions related to eligibility of treatment requests.
• Prioritizes treatment requests based on review type and ensures jurisdictional timeframes and or department turnaround times are met.
• Appropriately documents all systems to reflect critical thinking and actions taken in response to treatment requests.
• Ensures the privacy and security of Protected Health Information (PHI).
• Performs other administrative tasks and functionally related duties as assigned by clinical review nurses, nurse case managers or supervisor.
• Makes administrative decisions only, completes appropriate actions functioning under the direction of clinical staff and the Manager, Medical Case Management and within agreed upon limitations.
• Responds to general customer service questions or directs the caller to the appropriate person or department.
• Training and oversight of other Medical Management Liaisons and Assistants.

QUALIFICATION REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Knowledge of medical terminology CPT and ICD codes strongly preferred.
• Good typing skills, basic understanding of business technology and ability to learn new procedures quickly.
• Professional telephone demeanor and good oral and written communication skills.
• Ability to take direction, think critically and make decisions.
• Self-organized, detail oriented and be able to multi-task and work well under pressure in a fast-paced environment.
• Ability to work in a team environment.

1. EDUCATION and/or EXPERIENCE:

• High school diploma or equivalent required.
• Computer skills required with knowledge in utilizing Outlook, Microsoft Word, Excel and other databases.
• Prior medical assistant type experience and/or some knowledge of medical terminology.

Minimum 1-2 years Worker’s Compensation experience or experience in a health-related

• service field is helpful.

• Bilingual a plus.

2. LANGUAGE SKILLS

Ability to write letters, memos and reports that conform to prescribed style, format, and grammatical correctness.  Extensive clear, professional, and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.  Must be able to follow instruction and pay close attention to detail.

3. MATHEMATICAL SKILLS

Basic mathematical and ability to calculate figures and amounts helpful.

4. REASONING ABILITY

Ability to define problems, collect data, establish facts, and draw valid conclusions. 

5. CERTIFICATES, LICENSES, REGISTRATIONS

(N/A)

6. PHYSICAL DEMANDS

The physical demands described here 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.

While performing the duties of this job, the employee is regularly required to sit, talk and hear.  The employee frequently is required to use hands to operate a computer keyboard, handle, or feel and reach with hands and arms.  The employee is occasionally required to stand and walk.  The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

7. WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.