Job Summary
We are seeking a compassionate nursing professional to provide clinical and case management services. This position involves managing a caseload of patients to ensure they receive the care and support necessary for their recovery.
Key Responsibilities
- Manage an active caseload of 22-25 field case management files or 45-55 telephonic case management files, depending on complexity.
- Keep accurate time tracking with a minimum expectation of 40 billable hours per week for full-time medical case managers.
- Maintain an updated Outlook calendar with meetings and appointments, documenting changes for weekly review.
- Ensure all tasks are current and updated on a daily basis.
- Attend mandatory meetings, training sessions, or corporate events, whether in person or virtually.
- Conduct initial outreach within 24-48 hours of a referral and follow up with email notifications immediately after.
- Close files promptly, ensuring all internal documentation is current, including impact points.
- Apply case management protocols effectively.
- Collaborate with management and peers on complex cases, addressing issues and developing resolution strategies.
- Maintain comprehensive medical timelines and prepare case summaries for account claim reviews.
- Keep a complete and organized medical file in a paperless format.
- Notify management of any requests to deviate from established protocols and secure necessary approvals.
- Utilize cost management programs in accordance with organizational protocols.
- Analyze relationships between diagnoses, work injuries, and the medical treatments provided.
- Provide expert consultation on medical information interpretation and its implications on cases.
- Document expected dates for modified and full-duty work releases and address any deviations.
- Coordinate discussions with physicians regarding physical job demands to facilitate suitable work releases.
- Contact medical providers within 24 hours post-appointments for updates on disability and medical status.
- Document medical treatment appropriateness in line with established criteria throughout the claim process.
- Update employers and relevant parties on any changes in disability or medical status promptly after appointments.
- Comply with jurisdictional rules and regulations for each case.
- Participate in field visits as requested, typically within a 2-hour radius from the home office.
- Meet or exceed return-to-work outcomes and medical closure timelines.
- Engage in community wellness fairs and clinics as required.
Qualifications
To excel in this role, candidates should be detail-oriented with strong communication and interpersonal skills, comfortable with technology, and able to produce clear, concise reports. Preferred qualifications include:
- 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, and draw valid conclusions.
- Proficiency in Microsoft Windows/Office applications and general computer navigation with typing skills of 45+ wpm.
- Knowledge of workers' compensation jurisdictional rules/regulations is advantageous.
- Strong organizational skills with the ability to thrive in a fast-paced environment.
- Excellent written and verbal communication skills paired with exceptional customer service abilities.
- Previous experience in case management or clinical settings, particularly in orthopedic or occupational health is beneficial.
- Bilingual candidates are encouraged to apply.
- A valid driver's license and willingness to travel for appointments as necessary.
Core Competencies
- Customer Service: Handle challenging situations with empathy and respond promptly, seeking feedback to enhance service quality.
- Communication: Effectively articulate ideas and actively listen to ensure understanding and contribute to group discussions.
- Teamwork: Collaborate openly with colleagues, valuing diverse perspectives and fostering a positive team spirit.
- Ethics: Maintain integrity and respect in all interactions, inspiring trust and upholding organizational values.
- Adaptability: Respond effectively to changes and manage competing demands and unexpected challenges.
- Dependability: Exhibit consistency in presence and punctuality, ensuring work responsibilities are maintained during absences.
- Initiative: Take proactive steps in personal development and seek opportunities for increased responsibility.
- Judgment: Make informed decisions and engage appropriate individuals in the decision-making process.
- Motivation: Set and achieve ambitious goals while demonstrating persistence in overcoming obstacles.
- Professionalism: Maintain tact and respect in interactions, especially under pressure, and accept responsibility for actions.
- Quality: Strive for accuracy and continuous improvement.
Work Environment
This role is typically performed in a moderate noise environment, with reasonable accommodations available for individuals with disabilities.
Physical Demands
The position may require lifting or moving up to 10 pounds regularly. Candidates should be able to perform tasks involving hands, standing, walking, sitting, and reaching, along with necessary visual abilities for the role.
Employment Type: Full-Time