WTP - Medical Case Manager

Job Accountabilities:
• Ensure customer satisfaction by making contact with the client, medical provider and claim professional in a timely manner and according to Best Practices.
• Ensure customer service by proactively communicating information; responding to inquiries; and following customer specific protocols.
• Establish a case management plan by completing evaluation and recommend plan of action.
• Coordinate and communicate activities of the case management plan by maintaining ongoing communication with client, provider(s), and claim professional as appropriate and according to Best Practices.
• Manage activities associated with case by completing assignments from claims staff, utilizing Managed Care tools (Preferred Provider Organizations, preferred vendors), addressing issues and escalating as appropriate.
• Document information according to Best Practices (including case assessment, case management plan, follow-up communication, closure, billing, cost containment and return to work data).
• Meet quality standards by following best practices.
• Manage appropriate case load according to policy and ensure accurate billing of all case management activity.
• Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
• Acts as a technical resources by participating in presentations and provide education/ training sessions as needed, and/ or as requested by Manager.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
• Contribute to the team effort by accomplishing related results and participating on projects as needed.
• Protect Zurich’s reputation by keeping claims information confidential.
• Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
• Contribute to the team effort by accomplishing related results and participating on projects as needed.

JOB QUALIFICATIONS
 Preferred:
 
Registered Nurse in good standing with the College of Nurses of Ontario (copy of license to be provided annually). 
 
Desired Skills and Experience: 
•    At least 3 years of hospital experience in a clinical role 
•    Desirable Clinical Experience: Emergency Medicine & Trauma, Critical Care Medicine, Cardiology, Neurology, Orthopedics, Surgery 
•    Excellent communication skills (both written and verbal): 
•    ability to communicate at all levels with clarity and precision 
•    ability to liaise with multiple stakeholders and build consensus 
•    Proficient in computer systems and applications including MS office 
•    Ability to meet tight timelines under pressure while delivering quality service 
•    Display high energy, passion and a positive attitude 
•    Own the results and willingly seek and accept personal accountability 
•    Seek opportunities to continuously learn about new products, policies and client priorities and their expectations 
•    Assign a high priority to customer service excellence and understand the value of customer satisfaction in driving success 
•    Be flexible and personally embrace change
Unique Requirements:
•    Accurate data entry skills including reasonable typing speed 
•    Flexible to work in shifts (night shifts if business needs require) and willing to be available for on-call duties (after-hours) as per business needs

Assets: 
•    Fluent in additional languages, particularly French or Spanish 
•    Training/knowledge of Aerospace Medicine and Flight Physiology 
•    Knowledge of privacy acts: PIPEDA and HIPAA 
•    Previous Case Management experience 
•    Case Management certification, CRRN, CDMS, CCM or CRC 
•    Experience in travel insurance industry and/or managed care 
•    Experience in healthcare system of the United States & Canada

Please apply online at www.zurichcanada.com, Careers to requisition id # 95149