Medical Case Manager (US Medical Lien Specialty)

Shift: Monday - Friday, 10:30 PM - 7:30 AM Philippine Time

Rate: Php40,000 - 50,000/monthly

KEY RESPONSIBILITIES:

1. Full-Cycle Case Management & Strategy

• Intake & Suitability Assessment: Conduct intake calls to determine if a case is appropriate for funding based on accident details and insurance policy limits.
• Clinical Analysis: Review medical reports and physical therapy notes to identify injuries (e.g., cervical/thoracic pain) and monitor treatment progress.
• Causality & Red Flag Identification: Actively monitor for treatment "red flags," such as regressing patient progress, to determine if conservative care should be swapped for more effective, higher-value interventions like injections or surgery.
• Surgical & High-Cost Coordination: Secure necessary approvals for expensive procedures; coordinate pre-ops, lab work, and post-operative care.

1. Financial & Lien Oversight

• Policy Limit Gatekeeping: Monitor medical billing and treatment plans daily to ensure all costs remain strictly within the patient's insurance policy limits.
• Funding Approvals: Act as an internal "adjuster" to approve or deny orders for MRIs, X-rays, and pain management procedures.
• Master Ledger Management: Gather all final medical records, bills, and documentation to create a Master Ledger for the law firm’s litigation and demand process.

1. Network & Logistics Coordination

• Provider Relations: Serve as the primary bridge between the patient, medical providers, and attorneys to ensure smooth case progression.
• Patient Support: Coordinate patient logistics, including pharmacy medications and transportation (lifts) to appointments to ensure treatment compliance.
• Caseload Maintenance: Utilize CRMs (e.g., Contact Manager, Filevine) to "touch" every case in the pipeline daily, ensuring no case stagnates.
• 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.

QUALIFICATIONS:

• US Medical Lien Expertise: Must have direct experience working for a US-based Medical Lien or Funding company (experience in Utah, Colorado, or similar "at-fault" states is a plus).
• Medical Literacy: Ability to interpret CPT codes, surgical recommendations, and diagnostic results (MRIs/X-rays) independently. Review initial medical reports to assess injury severity and classify cases (e.g., conservative care vs. surgical intervention).
• Legal Lifecycle Knowledge: Deep understanding of the Personal Injury (PI) lifecycle, from initial intake and LOP (Letter of Protection) filing to the final demand/settlement phase.
• 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.

• CRM Proficiency: Experience using legal/medical case management software (e.g., Contact Manager, Filevine, Salesforce).
• Assertive Communication: Strong interpersonal skills for negotiating with provider offices and providing clear updates to attorneys.
• Detail Oriented: Proven ability to manage complex documentation requirements for high-cost surgeries and legal evidence

• Medical Background: Degree in Nursing (BSN) or a related healthcare field.
• Multi-State Policy Knowledge: Understanding of how insurance policies and lien laws differ across various US states.