Job Summary
We are seeking a compassionate and skilled nursing professional to provide exceptional clinical and case management services. You will manage a caseload of patients, ensuring they receive the necessary care and support 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, based on complexity.
- Maintain accurate time tracking, billing a minimum of 40 hours per week for full-time medical case managers.
- Keep your Outlook calendar updated with meetings and appointments, documenting changes.
- Ensure all tasks are current and updated daily.
- Participate in mandatory meetings, training sessions, or corporate events, either in person or electronically.
- Conduct initial outreach within 24-48 hours of a referral and send a follow-up email immediately afterward.
- Close files in a timely manner, ensuring all internal documentation is complete and up to date.
- 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.
- Maintain complete medical files in chronological order in a paperless format.
- Notify management of any requests to deviate from established protocols and obtain necessary approvals.
- Utilize cost management programs according to account or organizational protocols.
- Analyze relationships between diagnoses, work injuries, and medical treatments.
- Offer expert consultation on medical information interpretation and its impact on cases.
- Project expected dates for modified and full-duty work releases, documenting deviations.
- 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 throughout the claim duration.
- Update employers and relevant parties on changes in disability or medical status within 24 hours of appointments.
- Adhere to jurisdictional rules and regulations for each case.
- Participate in field visits as needed, typically within a 2-hour radius from 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
The successful candidate will be detail-oriented with outstanding communication and interpersonal skills. 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
- Problem-solving abilities and data analysis.
- Proficiency in Microsoft Windows/Office and general computer navigation, with typing skills of 45+ wpm.
- Knowledge of workers' compensation jurisdictional rules/regulations is advantageous.
- Strong organizational skills and 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.
- Valid driver's license and ability to travel for appointments.
Core Competencies
- Customer Service: Manage challenging situations with empathy and prompt responses.
- Communication: Clearly articulate ideas and listen actively to ensure mutual understanding.
- Teamwork: Collaborate openly with colleagues, valuing diverse perspectives.
- Ethics: Uphold integrity and respect in interactions.
- Adaptability: Respond effectively to changes in the work environment.
- Dependability: Consistently present and punctual.
- Initiative: Seek opportunities for development and increased responsibility.
- Judgment: Make sound decisions and involve appropriate individuals in the decision-making process.
- Motivation: Set and achieve ambitious goals while demonstrating persistence.
- Professionalism: Interact with tact and respect under pressure.
- Quality: Strive for accuracy and continuous improvement.
Work Environment
This role is typically performed in a moderate noise environment. Reasonable accommodations can be made for individuals with disabilities.
Physical Demands
The position may require lifting or moving up to 10 pounds regularly. Candidates should be able to use their hands for various tasks and 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