Job Description
Job Summary
We are seeking a dedicated and compassionate nursing professional to provide clinical and case management services. In this role, you will manage a diverse caseload, ensuring effective communication and support for our clients.
Key Responsibilities
Manage a caseload of 22-25 active cases for full field management, or 45-55 cases for telephonic management, adjusting based on case complexity. Part-time employees will manage a caseload of 12-18 cases based on acuity, as determined by the supervisor.
Maintain a minimum of 40 billable hours per week for full-time medical case managers; part-time hours will be discussed with your supervisor.
Keep your Outlook calendar updated with all meetings and appointments, documenting any changes as they arise for weekly review.
Ensure all tasks are current and updated daily.
Attend all mandatory meetings, training sessions, or corporate events, either in person or electronically, as required.
Make initial contact with clients within 24-48 hours of referral and send a follow-up email immediately afterward.
Close files in a timely manner, ensuring internal documentation is complete and up to date, including impact points.
Demonstrate proficiency in applying case management protocols.
Collaborate with your manager and team to address complex cases, claim barriers, and resolution planning.
Create comprehensive medical timelines and prepare case summaries for account claim reviews.
Maintain organized and complete medical files in a paperless format, ensuring chronological order and avoiding duplication.
Notify your manager of any requests to deviate from established protocols and seek necessary approvals.
Utilize cost management programs in accordance with company protocols, such as Pharmacy and DME.
Conduct initial and ongoing analysis of diagnoses related to work injuries and medical treatments.
Provide expert consultation on medical information and its implications for each case.
Project anticipated dates for modified and full-duty work releases based on disability and medical criteria, documenting any deviations at appointments.
Regularly assess physical job demands and availability to support appropriate work releases.
Contact medical providers within 24 hours of appointments to obtain updates on disability and medical statuses.
Keep employers and relevant parties informed of any changes in disability or medical status and coordinate return-to-work efforts as per protocol.
Adhere to jurisdictional rules and regulations, applying them appropriately to each case.
Attend field visits as requested by clients and account protocols, typically within a two-hour radius from your home office.
Strive to meet or exceed guidelines for return-to-work outcomes and medical closure durations.
Participate in public health community wellness fairs and clinics as needed.
If you are in a PRN role, you will perform tasks as requested and attend appointments according to field guidelines.
Qualifications
To excel in this role, you should be detail-oriented with exceptional communication and interpersonal skills. Comfort navigating computer systems and writing detailed reports is essential. The following qualifications are preferred:
Active RN licensure in the state of employment.
Bachelor's degree is preferred.
Additional certifications (e.g., CCM, CDMS, CLNC) are a plus.
Skills and Abilities
Strong reasoning skills to define problems, collect data, and draw valid conclusions.
Proficient in Microsoft Office (Word, Excel, Outlook) and general computer navigation. Typing speed of 45+ wpm is desirable.
Knowledge of workers' compensation regulations is beneficial.
Ability to thrive in a fast-paced environment with strong organizational skills.
Excellent written and verbal communication skills, along with a commitment to outstanding customer service.
Previous case management and clinical experience in orthopedic or occupational health settings is a plus.
Bilingual candidates are encouraged to apply.
Valid driver's license and ability to travel to appointments as needed for field case management.
Core Competencies
To succeed in this role, you should demonstrate the following competencies:
Customer Service: Manage challenging situations with empathy; respond promptly to client needs and feedback.
Communication: Speak clearly and persuasively; listen actively and respond to questions.
Teamwork: Collaborate effectively with colleagues; support team goals and recognize others' contributions.
Ethics: Uphold organizational values and maintain integrity in all interactions.
Adaptability: Adjust to changing environments and manage competing demands effectively.
Dependability: Consistently meet work responsibilities and commitments, maintaining a punctual and reliable presence.
Initiative: Seek opportunities for professional development and take on additional responsibilities.
Professionalism: Interact with respect and consideration for all individuals; accept responsibility for your actions.
Work Environment
The work environment is typically moderate in noise level. Reasonable accommodations will be made to enable individuals with disabilities to perform essential functions.
Physical Demands
The role may require frequently lifting or moving items up to 10 pounds. Regular activities include using hands for tasks, talking, hearing, standing, walking, sitting, and reaching. Vision abilities needed 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, Relief, Immediate start, Remote job, Home office,