Job Description
Job Summary
We are looking for a compassionate and skilled nursing professional to provide exceptional clinical and case management services. In this role, you will manage a caseload of patients, ensuring they receive the care and support they need throughout their recovery process.
Essential Duties and Responsibilities
Manage an active caseload of 22-25 field case management files, or 45-55 telephonic case management files, depending on complexity. Part-time staff will manage 12-18 files based on acuity, as determined by supervision.
Maintain accurate time tracking, with full-time medical case managers expected to bill a minimum of 40 hours per week. Part-time hours will be discussed individually.
Keep your Outlook calendar up to date with meetings and appointments, documenting any changes throughout the week for weekly review.
Ensure all tasks are current and updated daily.
Attend and participate in all mandatory meetings, training sessions, or corporate events, either in person or electronically.
Conduct initial outreach within 24-48 hours of a referral, sending a follow-up email immediately afterward.
Close files in a timely manner, ensuring all internal documentation is complete and up to date, including impact points.
Apply case management protocols effectively.
Collaborate with management and peers on complex cases, addressing claim barriers and developing resolution plans.
Create and maintain comprehensive medical timelines and prepare case summaries for account claim reviews.
Keep a complete medical file in chronological order, ensuring no duplication of information in a paperless format.
Notify management of any requests to deviate from established protocols and obtain necessary approvals.
Utilize cost management programs as per account or organizational protocols (e.g., Pharmacy, DME).
Analyze the relationship between diagnoses, work injuries, and the medical treatment provided.
Offer expert consultation on medical information interpretation and its impact on cases.
Project expected dates for modified and full-duty work releases, documenting any deviations during appointments.
Discuss physical job demands and availability with physicians to encourage suitable work releases.
Contact medical providers within 24 hours after appointments to obtain updates on disability and medical status.
Document the appropriateness of medical treatment, ensuring it meets established disability/medical criteria throughout the claim duration.
Update employers and relevant parties on any changes in disability or medical status within 24 hours of appointments and coordinate return-to-work efforts according to protocol.
Adhere to jurisdictional rules and regulations for each case.
Participate in field visits as needed and as requested by clients, typically within a 2-hour radius from your home office.
Meet or exceed guidelines for return-to-work outcomes and medical closure durations.
Engage in community wellness fairs and clinics as required.
Qualifications
To be successful in this role, you should be detail-oriented with outstanding communication and interpersonal skills. The ideal candidate will be comfortable navigating technology and producing clear, concise reports. The following qualifications are preferred:
Active RN licensure in the state of employment.
Bachelor's degree preferred.
Additional certifications such as CCM, CDMS, or CLNC are a plus.
Skills and Competencies
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Proficiency in Microsoft Windows/Office (Word, Excel, Outlook) and general computer navigation, with typing skills of 45+ wpm.
Knowledge of workers' compensation jurisdictional rules/regulations is advantageous.
Strong organizational skills and the ability to thrive in a fast-paced environment.
Excellent written and verbal communication skills, along with exceptional customer service abilities.
Previous case management or clinical experience in orthopedic or occupational health settings is beneficial.
Bilingual candidates are encouraged to apply.
A valid driver's license and the ability to travel to appointments as needed for field case managers.
Core Competencies
Customer Service: Manage challenging customer situations with empathy and prompt responses, seeking feedback to enhance service quality.
Communication: Clearly articulate ideas and listen actively to ensure mutual understanding, contributing to effective group discussions.
Teamwork: Collaborate openly with colleagues, valuing diverse perspectives and fostering a positive team spirit.
Ethics: Uphold integrity and respect in all interactions, inspiring trust and maintaining organizational values.
Adaptability: Respond effectively to changes in the work environment, managing competing demands and unexpected challenges.
Dependability: Be consistently present and punctual, ensuring that work responsibilities are covered when absent.
Initiative: Take proactive steps in your development and seek opportunities for increased responsibility.
Judgment: Make sound decisions and involve appropriate individuals in the decision-making process.
Motivation: Set and achieve ambitious goals while demonstrating persistence in overcoming obstacles.
Professionalism: Interact with tact and respect, even under pressure, while accepting responsibility for your actions.
Quality: Strive for accuracy and continuous improvement in your work.
Work Environment
This role is typically performed in a moderate noise environment. Reasonable accommodations can be made to enable individuals with disabilities to fulfill essential functions.
Physical Demands
The physical demands of this position may require lifting or moving up to 10 pounds regularly. Candidates should be able to use their hands for various tasks, engage in standing, walking, sitting, and reaching activities. Visual abilities necessary for the role include close vision, distance vision, and the ability to adjust focus.
Employment Type: Full-Time
Salary: $ 75,000.00 82,000.00 Per Year
Job Tags
Full time, Part time, Immediate start, Home office,