Bilingual Medical Case Manager (Us Medical Lien Specialty)

We are seeking a highly skilled and experienced Clinical Review and Lien Management Specialist to join our team. This role is crucial for ensuring the appropriate clinical review, treatment authorization, and efficient case progression in personal injury matters, while also managing financial aspects and liens. The specialist will play a key role in protecting our financial interests and facilitating timely case resolution.

Key Responsibilities:
* Clinical & Causality Review: Review medical records to assess injury severity and treatment appropriateness. Validate medical necessity for advanced treatments (MRI, injections, surgery). Ensure treatments are accident-related and distinguish pre-existing conditions.
* Financial & Lien Management: Approve or deny treatment funding based on policy limits and settlement value. Manage Letters of Protection (LOPs) and lien documentation. Review provider billing for accuracy and prevent upcoding.
* Case Flow & Provider Coordination: Direct patients to approved lien providers within an appropriate radius. Reduce no-shows and treatment delays. Push cases efficiently from treatment to settlement readiness.
* Stakeholder Communication: Act as the primary liaison between patients, providers, and Personal Injury (PI) attorneys. Resolve treatment denials and billing disputes.

Required Qualifications:
* Strong clinical literacy, including the ability to interpret medical records, imaging, and treatment plans.
* Experience with legal/medical CRMs (e.g., FileVine, Salesforce, SmartAdvocate).
* Comprehensive understanding of the PI case lifecycle and the impact of medical billing on settlements.

Preferred Qualifications:
* 2+ years of experience in US Personal Injury (either from a law firm or medical lien/funding background).
* Healthcare background (e.g., Nursing, Physical Therapy, or similar).
* Proven experience with Letters of Protection (LOPs) and medical lien negotiation.