One Call

Join Our Team and Make a Difference! 

Are you looking for an impactful role where you finish the workday knowing you helped someone? Whether you're part of our care coordination team or playing a supporting role, the work our colleagues do every day helps us collectively reach our mission of getting people the care they need when they need it. By staying committed to our core values - Think Big, Go Fast, Deliver Awe and Win Together - we can positively impact the lives of the injured workers we serve and get them back to the things that matter most in life. 

Salary Range:

This compensation range takes into consideration a wide range of factors, including, but not limited to, skill set, experience and training, licensure and certifications and other business and organizational needs. The disclosed range estimate is not adjusted for geographic differential associated with the location where the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.  

What We Provide in Return for Your Commitment to our Mission 
We offer a vast array of benefits to help support the whole you including:  

• Remote Work: We are a remote-first company and almost all positions receive the flexibility of working from home.
• Generous Time Off: In addition to 8 company holidays and 2 floating holidays every year, all colleagues receive a minimum of 18 days of paid time off.
• Comprehensive Benefits Package: Including medical, dental, vision and pet insurance; 401(k) matching program; and company-paid life insurance and short and long-term disability coverage. 
• Supportive Services: Just like our colleagues get people the care they need when they need it, we want to do the same for our colleagues in their time of need. From a Colleague Assistance Program that offers free counseling and financial services to our One Call Foundation, a non-profit arm of our company which provides colleagues financial assistance during times of unexpected hardships. 

JOB SUMMARY:

Responsible for completing clinical QA audits and/or plan of treatment reviews specific to their licensure and scope of practice. Reviews to provide recommendations related to the medical necessity for ongoing care progression of treatment appropriateness of past treatments and billing accuracy. The Clinical Reviewer’s primary stakeholder is the client (Adjuster/NCM) and must ensure their review/explanation assists and does not hinder the client from making the best decision on how to proceed with the file regardless of their opinions on the treatment that should be performed. Also responsible for providing clinical expertise and collaboration on other One Call processes and customer issue resolutions.

GENERAL DUTIES & RESPONSIBILITIES: 

    Review Evaluations plan of treatments progress notes and other clinical documentation and provide a report of clinical guidance to client within 48-72 hours of request dependent on type.

    Responsible for calling the treating provider to discuss findings and recommendations with the goal of securing mutual agreement and to coordinate communication to patient and MD of any revised plan of treatments.

    May be responsible for calling client to discuss authorization and/or follow up on Plans of Treatment continuation of care or other clinical treatment recommendations.

    Responds to the financial team’s requests within 48 hrs. to assist in processing claims received.

    Acts as a resource for other staff answering questions and giving guidance when needed on clinical questions within their scope of practice.

    Collaborates with Operational leaders to share opportunities for improvement with referral data quality.

    Works all special reports distributed by a supervisor/manager.

    Reviews and responds to any requests from clients provider claimant or supervisor and performs necessary action steps within 48 hrs.

    Consistently demonstrates a positive attitude and an overall commitment to excellence and is a team player.

    Actively participates in continuous operational improvements. Specific activities include but are not limited to offering feedback to management related to process working closely with provider development team to address provider issues collaborating with financial team to improve efficiency and participates in training/mentorship initiatives.

    Assists in obtaining necessary clinical documentation from provider as needed.

    Is open to coaching and willing to find more efficient processes when applicable.

    Performs miscellaneous tasks and projects as assigned by management.

    Demonstrates knowledge of CPT and ICD9/10 codes

    Reviews and corrects in-accurate coding on referral. 

    Assists in provider appeals related to authorization or payment as needed and related to clinical determination.

    Participates in provider scoring and complaint review as requested.

    Utilizes and maintains general knowledge of insurance reimbursement and specific knowledge of One Call Care Management processes.

    Participates in staff meetings office presentations training orientation and conference calls as directed.

    May participate internal file QA to ensure appropriate care coordination internally.

    Can always maintain professional composure and demeanor with both internal and external communications and interactions including discussing modified/reduced treatment with our providers.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS:

Minimum bachelor’s degree (B.A. or B.S.) and current physical or occupational therapy license and practiced for a minimum of 5 years within an outpatient orthopedic setting. Worker’s compensation treatment experience strongly preferred but not required.

GENERAL KNOWLEDGE SKILLS & ABILITIES:

    Ability to read analyze and interpret a vast variety of both handwritten and electronic medical reports professional journals newsletters technical procedures and/or government regulations. Ability to write business correspondence and completion of business forms.

    Ability to effectively present information and respond to questions from colleagues Adjustors Nurse Case Managers Providers and Provider’s office staff.

    Ability to create and utilize Microsoft Word documents and Excel spreadsheets.

    Ability to define problems collect data establish facts and draw valid conclusions.

    Must have the ability to work with and have knowledge of the physician community managed care pre-certification and utilization review.

    Must have knowledge of workers’ compensation.

    Must be able to collaborate with individuals at all levels of the organization.

    Knowledge of the Internet and how to research information is preferred.

    Must be able to maintain a professional appearance and exhibit strong interpersonal verbal and written communication skills for both internal and external customers including discussing modified/reduced treatment with our providers. 

    Must be able to organize work to ensure tasks are completed in a timely manner.

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