Workers Compensation Telephonic Nurse Case Manager

Job Description:

• Assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers
• Coordinate and implement medical case management to facilitate case closure
• Timely and comprehensive communication with employers, adjusters and the injured workers
• Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care
• Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure
• Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction
• Acquire and maintain nursing licensure for all jurisdictions as business needs require
• Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services
• Document activities and case progress using appropriate methods and tools following best practices for quality improvement
• Reviewing job analysis/job description with all providers to coordinate and implement disability case management
• Engage and participate in special projects as assigned by case management leadership team
• Occasionally attend on site meetings and professional programs
• Foster a teamwork environment
• Maintaining and updating evidence based medical guidelines in reference to the injured worker treatment plan and work status
• Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed
• Obtain case management professional certification (CCM) within 2 years of hire date
• Earn Continuing Education Units to maintain certifications and licensures

Requirements:

• Minimum 2 years of experience in workers compensation insurance and medical case management preferred
• Minimum of 4 years medical/surgical clinical experience required
• Exhibit strong communication skills, professionalism, flexibility and adaptability
• Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry
• Demonstrate evidence of self-motivation and the ability to perform case management duties independently
• Demonstrate evidence of computer and technology skills
• Oral and written fluency in both Spanish and English a plus
• Graduate of an accredited school of nursing and possess a current RN license
• RN compact license preferred, CCM preferred, Bachelor of Nursing preferred

Benefits:

• Health, Dental, Vision, Life, Disability
• Wellness
• Paid Time Off
• 401(k) and Profit-Sharing plans

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