Description
We are seeking a Telephonic Nurse Case Manager to join our team. As a Telephonic Nurse Case Manager, you will be responsible for monitoring, evaluating, and coordinating the delivery of high-quality, timely, and cost-effective medical treatment and other health services under Workers’ Compensation law.
Key Responsibilities
- Provide telephonic case management in a Workers’ Compensation environment, focusing on medical appropriateness of care to injured workers with cost savings by coordination and utilization of all services.
- Facilitate communication between the employee, employer, insurer, healthcare provider, and other stakeholders to achieve goals.
- Ensure appropriate education is provided to the injured employee and document in the system.
- Identify barriers to recovery and formulate a plan to overcome them.
- Clinically evaluate the recovery needs of an injured employee and provide ongoing assessment of health and medical records.
- Evaluate treatment plans, track and modify as necessary, and document outcomes.
- Track protocol management for appropriate utilization and delivery of medical services.
- Serve as a patient advocate, adhering to all legal, ethical, and accreditation/regulatory standards.
Skills, Knowledge & Expertise
- RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational).
- One of the following certifications: CCRN, CCM, CDMS, COHN, COHN‐S if managing a WC/MCO claim.
- At least 1 year of experience handling Workers’ Compensation case management.
- Proof of current State Licensure and eligible for endorsement in all other states.
- Bi-lingual – fluent English/Spanish helpful.
- Case-management experience mandatory – at least 1 year Workers’ Compensation.
- Field case or catastrophic case management and utilization review experience is highly preferred.
- Ability to demonstrate strong focus on cost containment to manage cases in the most cost-effective way while ensuring quality medical care.
- Maintain knowledge of current trends, standards, and law changes.
- Self-directed and able to work independently.
- Effective operation of a personal computer and related claims and business software.
- Good communication skills, both oral and written.
- Team player with superb customer service skills.
Benefits
- Medical, dental, and vision plans.
- 401(k) plan with employer matching.
- Time-off policies, including Discretionary Time Off (DTO) and Paid Time Off (PTO).
- Paid holidays.
- Life insurance and short-term and long-term disability coverage.