Schedule: 10:00pm - 7:00am PH time (8:00am - 5pm MDT)
Medical Case Manager – Personal Injury and Medical Liens
Role Overview
We are seeking an experienced Medical Case Manager to oversee personal injury cases throughout the treatment and medical-lien process. This role requires strong clinical judgment, financial awareness, and knowledge of the U.S. personal injury lifecycle.
The successful candidate will evaluate medical records and treatment requests, coordinate lien-based care, manage provider relationships, and serve as the primary liaison among patients, medical providers, and personal injury attorneys.
Key Responsibilities
Clinical Strategy and Causality Analysis
- Review initial medical reports to assess injury severity and classify cases, including conservative care and surgical intervention.
- Analyze medical notes to determine whether advanced treatments, such as MRIs and injections, are clinically justified before approving funding.
- Ensure treatment plans are directly related to the motor vehicle accident.
- Differentiate new injuries from pre-existing conditions to protect the value of the medical lien.
Financial Gatekeeping and Claims Management
- Serve as the primary decision-maker for treatment funding requests.
- Approve or deny requests based on policy limits and estimated settlement value.
- Manage the end-to-end medical-lien process and ensure all Letters of Protection are properly executed and filed.
- Compare provider billing with clinical documentation to identify possible upcoding.
- Ensure billed amounts are reasonable and aligned with medical-funding industry standards.
Provider Network and Case Pipeline Management
- Direct patients to approved providers within the company's lien-partner network.
- Identify and evaluate qualified providers near each patient's residence.
- Help minimize missed appointments and maintain treatment consistency.
- Monitor cases throughout the treatment phase and prevent unnecessary delays.
- Ensure each file is complete and ready to proceed to the settlement phase.
Stakeholder Coordination
- Serve as the primary point of communication among patients, medical providers, and personal injury attorneys.
- Provide clear and timely updates regarding treatment, documentation, billing, and case progress.
- Resolve concerns involving denied treatments, billing discrepancies, and case requirements.
- Coordinate with provider offices and legal teams to maintain efficient case progression.
Required Qualifications
- Ability to independently interpret surgical recommendations, diagnostic imaging results, and complex clinical narratives.
- Strong understanding of medical billing and its impact on the net recovery of a personal injury settlement.
- In-depth knowledge of the U.S. personal injury case lifecycle: Intake Treatment LOP/Lien Filing Demand Settlement.
- Strong analytical, decision-making, and case-management skills.
- Excellent written and verbal English communication skills.
- Ability to manage sensitive medical and legal information with accuracy and confidentiality.
Preferred Qualifications
- At least two years of experience supporting a U.S. personal injury law firm or medical funding/lien company.
- Bachelor's degree in Nursing, Physical Therapy, or a related healthcare field.
- Experience negotiating medical liens or working with third-party funding companies.
- Hands-on experience managing Letters of Protection.
- Proficiency in legal or medical CRM platforms such as Filevine, Salesforce, or SmartAdvocate.
- Familiarity with at-fault insurance states, particularly Colorado and Arizona.
- Bilingual proficiency in English and Spanish is an advantage.
