Role: Medical Case Manager
Shift: Monday - Friday, 10:30 PM - 7:30 AM Philippine Time
Rate: Php45,000/monthly
Key Responsibilities
1. Clinical Strategy & Causality Analysis- Medical Record Interpretation: Review initial medical reports to assess injury severity and classify cases (e.g., conservative care vs. surgical intervention).
- Clinical Justification: Analyze daily medical notes to validate the necessity of advanced treatments (MRIs, injections, etc.) before funding is approved.
- Causality Verification: Ensure treatment plans are directly tied to the motor vehicle accident (MVA) and differentiate new injuries from pre-existing conditions to protect the lien value.
2. Financial Gatekeeping & Claims Management- Internal Adjuster Functions: Act as the primary decision-maker for funding. Approve or deny treatment requests based on Policy Limits and the estimated settlement value.
- Lien Coordination: Manage the end-to-end lien process, ensuring all Letters of Protection (LOPs) are executed and filed correctly.
- Billing Oversight: Review provider billing against clinical notes to ensure upcoding is not occurring and that the billed amounts align with industry standards for medical funding.
3. Network & Pipeline Logistics (Traffic Control)- Provider Network Management: Direct patients to providers within the approved Lien Partners network.
- Radius & Compliance Management: Locate and vet providers near the patient's residence to minimize no-show rates and ensure treatment consistency.
- Cycle Management: Actively push cases through the Treatment Phase to ensure the file is ready for the Settlement Phase without unnecessary delays.
4. Stakeholder Liaison- The Bridge Role: Serve as the central point of communication between the Patient, Medical Provider, and the Personal Injury Attorney.
- Dispute Resolution: Handle communication regarding denied treatments or billing discrepancies with provider offices and legal teams.
Qualifications
Technical Requirements- Clinical Literacy: Must be able to independently interpret surgical recommendations, diagnostic imaging results, and complex clinical narratives.
- Systems Proficiency: Experience with legal/medical CRMs (Filevine, Salesforce, Smart Advocate) is highly preferred.
- Financial Literacy: Understanding of how medical billing impacts the net recovery in a personal injury settlement.
Experience & Background- Lifecycle Expertise: A deep understanding of the PI lawsuit lifecycle: Intake > Treatment > LOP/Lien Filing > Demand > Settlement.
- State-Specific Knowledge: Familiarity with At-Fault insurance states (e.g., Colorado, Arizona) is a significant advantage.
Preferred (Bonus) Qualifications- US Personal Injury (PI) Experience: Minimum 2+ years supporting a US PI Law Firm or a Medical Funding/Lien company.
- Medical Degree: BS Nursing, Physical Therapy, or similar healthcare degree.
- Lien Specialist Background: Specific experience negotiating medical liens or coordinating with third-party funding companies. Letters of Protection (LOP).
