Medical Case Manager

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.