Description

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

Join our dedicated team ensuring appropriate treatment and billing integrity for worker's compensation claims. As a Telephonic Case Manager, with a specific focus on treatment plan compliance, you will work within a specialized federal framework to ensure treatment plan adherence and appropriate billing practices. In this role, you will interface with treating physicians/providers to request, document, and monitor treatment plans while verifying that all services billed align with the approved plan of care.

In this role, you will:

• Utilize national treatment guidelines to document, track, and evaluate treatment plans for injured/disabled individuals
• Request and secure detailed treatment plans from medical providers, serving as the primary point of accountability for plan documentation
• Hold physicians and providers accountable to the established treatment plans, monitoring for deviations and addressing them promptly
• Verify that all billed services directly correspond to the approved treatment plan, flagging discrepancies for review
• Demonstrate knowledge of regulatory requirements and compliance standards within federal guidelines
• Use knowledge of types of injury, medications, treatment options, and treatment alternatives to effectively evaluate proposed treatment plans
• Review documentation to assess whether treatments align with diagnosed conditions and national guidelines
• Communicate with providers regarding treatment plan adjustments and billing discrepancies
• Document all interactions within the federal system to maintain comprehensive records
• Independently manage workload, including prioritizing cases and deciding how best to manage compliance effectively
• Complete other duties as assigned, such as preparing compliance reports and assisting in training/orientation of new staff as requested

This position requires exceptional attention to detail, strong documentation skills, and the ability to maintain provider accountability while ensuring services billed to our company align precisely with approved treatment plans.

• Education: Associates Degree or Bachelor's Degree in Nursing or related field.
• Experience: 2+ years clinical practice preferred. Workers' compensation-related experience preferred.
• Skills: Ability to advocate recommendations effectively with physicians/providers, employers, and customers. Ability to work independently. Knowledge of basic computer skills including Excel, Word, and Outlook Email. Proficient grammar, sentence structure, and written communication skills.
• Certifications, Licenses, Registrations:
  • Active Registered Nurse (RN) license required. Must be in good standing.
• Internet: Must have reliable internet.

PI278939016