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DUNS: 829197503 | FEIN: 26-3089577 | Cage Code: 5FCT4
Job Openings >> Medical Case Manager
Medical Case Manager
Summary
Title:Medical Case Manager
ID:5197
Department:Healthcare
Location:Smyrna, TN 37167
Description

Job purpose

To provide assistance with Medical Management support services for 8-koi; a diverse Florida based service and consulting company that has been providing outstanding results for our clients for over 25-years now.

Duties and responsibilities

  • Provide Medical and Dental Non-clinical Medical Case Management. The non-clinical Medical Management Team (MMT) consists of the Medical Manager and Care Coordinator. Medical Management knowledge domains consist of assessment, planning, implementation, coordination, reporting, monitoring and evaluations of the options and services required to meet the ARNG Soldier’s health and human service’s needs. Key personnel are required for service as Medical Case Manager(s) and Care Coordinator(s). All care coordinators are responsible for working dental vouchers for each soldier under their responsibility.
  • Review individual Soldier medical information in order to ascertain the medical status of injuries, illnesses, or diseases. The contractor shall not determine the medical or dental fitness of an individual or group. The contractor shall review materials collected and advise DSS and command on the medical status of Soldiers.
  • Monitor and input information into Medical Operational Data System (MODS) that is an integrated automation system that supports all phases of Human Resource Life-Cycle Management in both peacetime and mobilization.
  • Review and make entries into the Automated Voucher System (AVS). Facilitate the medical readiness of the Army National Guard (ARNG) by providing web-based services creating and tracking requests for medical services through RHRP program, additionally, support the PDHRA/DHAP program for mass event creation.
  • Review and report dental status on Dental Classification (DenClass) module used to electronically document the dental readiness with the Medical Operational Data System (MODS) architecture. Assist in the creation and tracking of all elements of a dental examination including: The Soldier’s health history, SF 603A, the dental treatment plan, and a digital repository for dental radiographs.
  • Review the Electronic Case Management (eCase) module. Open, track, and report provider determinations concerning the disposition of medical cases for Army National Guard Soldiers. Through eCase module provide an automated case-management workflow and task-management system that provides an integrated view of all related data that is obtained from other medical management systems.
  • Review entries into the Electronic Medical Management Processing System (eMMPS) module used by Army National Guard. Report on the status, provide documentation when needed, and work with agencies to complete requests for, Incapacitation Pay Claim (INCAP) cases, Post-Deployment Health Re- Assessment (PDHRA) referrals, Military Medical Support Office (MMSO) now known as the Defense. Health Agency, Great Lakes (DHA-GL) Pre-Authorization cases, and Active Duty Orders Process (ADOP) cases.
  • Review and submit documentation into the Health Readiness Record (HRR) module provides the ARNG with a web-based repository for Soldier medical, dental, and medical personnel action documentation. Soldier records include non-sensitive, sensitive, and behavioral health documents. Collected medical documentation provided by various entities to include, but are not limited to the individual Soldier, unit, Medical Readiness NCO (MRNCO), Medical Treatment Facility, and Primary Care Physician.
  • Review and submit entries into the Medical Action Tracking System (MATS), a web-based, workflow module for authorized users which manages medical waiver requests, General Officer Physicals, and Convalescent Leave requests. The module is an electronic means of submission, receipt, storage, processing, and tracking of the medical actions and waivers from Soldiers, Recruiting and Retention Managers (RRMs), and Military Entrance Processing Stations (MEPS) to the Clinical Section of the Army National Guard (ARNG) Surgeon’s Office.
  • Review and submit information into Reserve Component Automation Systems (RCAS), Mobilization Planning Data Viewer (MPDV) is the system within RCAS used in managing mobilization, safety, personnel and force authorization.
  • Utilize the Armed Forces Health Longitudinal Technology Application (AHLTA), the military’s electronic health record, a clinical information system that generates, maintains, stores, and provides secure electronic access to comprehensive patient records. The system is used by the active components of the Army, Navy, and Air Force Military Treatment Facilities (MTF).
  • Responsible for tracking medical status of ALL assigned Soldiers.
  • Responsible for input of medical charting in MEDCHART; The contractor may merge responsibilities found in other positions to reduce duplication of the same duties (provide information in your proposal that indicates who will be responsible)
  • Request medical documentation from Soldier, Medical Treatment Facility, Medical Providers, and other resources associated with SM medical care.
  • Track Soldier treatment plans with appropriate medical facilities.
  • Maintain automated referrals indicated in MEDCHART. The contractor may merge responsibilities found in other positions to reduce duplication of the same duties (provide information in your proposal that indicates who will be responsible)
  • Submit case processing, medical documentation, and profile concerns to military/contacted provider.
  • Attend Medical Readiness Event (MRE) as determined by the needs for the state and the individual units.
  • Ensure those Soldiers under managed care from identification of condition to when the Soldier is either:

-Considered medically ready.

-Administratively separated from the military.

  • Follow the regulations and policies applicable to Individual Medical Readiness (IMR) and deployment.
  • Report medical readiness to the MRNCO, Commander or designated representative to include Dental Readiness (DRC3 and D/RC4) and Medical Readiness Deployability (MRC3, MRC4-PHA, and HIV/IMR/IMM) requirements.
  • Ensure all medical documentation received from the Soldier, unit, or medical provider is placed in appropriate electronic record, as well as the Soldiers Treatment Record (STR).
  • Maintain STRs in accordance with Army Regulation (AR) 40-66.
  • Obtain release of information from Soldier.
  • Educate Soldiers on resources available to improve medical and dental readiness.
  • Maintain Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards and guidelines
  • Review and track health assessment MRE lab results, contact SM and educate on lifestyle modifications.
  • Upload medical documents of case management Soldiers into HRR
  • Upon request stamp all medical documents for verification after uploading.
  • Index and validate documents uploaded into HRR.
  • Upload information into MODS, enter immunizations, designation of pregnancy, eye exams, lab results, and medical warning tags
  • Provide all medical documents received for case management to Records Custodian. Assist with the process of filing medical records into individual Soldiers STR. If a document evidence transfer is requested. Copy of each supporting transfer document shall be provided to the COR at the end of each month no later than 7 calendar days at the end of the month.
  • Ensure that all administrative charting in MEDCHART is completed.
  • Track medical appointments by communicating with unit to ensure Soldier attendance and submission of follow up documentation. Chart appointment attendance and relay information to the appropriate offices upon request.
  • Log into MEDCHART any significant contact with SM (email, voice mail, or personal interview).
  • Run MEDPROS report post MRE. Supply copy to HSS and MRNCO assigned to unit. Monitor MEDPROS to ensure all scheduled services are completed/updated and current medical status is reflected.
  • Communicate with delegated government personnel to track compliance versus noncompliance.
  • Ensure Soldiers duty limitations and/or with T3, T4, P3, or P4 profiles are case managed in MEDCHART.
  • Case Managers shall review medical documentation and prepare Narrative Summary prior to submission to the State Surgeon’s Office for clinical decisions.

Qualifications

  • Must be able to obtain US Government Security Clearance
  • Shall possess a Bachelor’s Degree, but nursing license is preferred for Case managers that draft narrative summaries, review medical information, advise personnel on duty restrictions, recommend profiling restrictions, provide waiver recommendations, and advise the Deputy State Surgeon (DSS) on deployment ability.
  • Possess a minimum of one-year experience working in Case Management
  • Familiar with the Microsoft office suite, office machines, such as photocopiers and scanners, facsimile machines, personal computer, and telephones
  • Excellent written, oral, and telephone communication skills
  • Ability to operate office machines, such as photocopiers and scanners, facsimile machines, voice mail systems and personal computers
  • Must have excellent communication, phone etiquette, customer service and people skills, as well as be able to multitask and stay organized
  • Ability to multi-task and work independently, and have a sharp attention to detail.

Working conditions

Working conditions are within a normal office environment.

Physical requirements

Normal office environment mobility; sitting, walking, bending, stooping, standing, lifting a maximum of 25 pounds (greater than 25 pounds requires a two-person lift), turning, pushing. Normal office dexterity, to include; reaching, handling, grasping, to include typing/keyboard, and phone use.

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