Experienced Telephonic Nurse Case Manager to monitor, evaluate and coordinate the delivery of high quality, timely, cost effective medical case management services under Workers’ Compensation law, as needed by an injured employee to promote an appropriate, prompt return-to-work when medically indicated. Telephonically directs and manages health care for injured workers; recognizing the need to use utilization review process, including pre-certification, concurrent review and retrospective review. Hours flexible.
Essential Duties and Responsibilities
Assesses disability status, makes recommendations and identifies appropriate resources.
Gathers and coordinates medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and addresses length of disability.
Consults on case management issues in area of specialty and applies effective case management interventions.
Works with medical and other providers to ensure appropriate treatment and return to work.
Addresses causality and refers to appropriate medical expertise.
Skills, Abilities and Knowledge
Strong knowledge of case management, medical terminology and conditions, insurance industry as well as company policies and procedures.
Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service.
Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner.
Strong interpersonal skills with the ability to effectively interact with internal and external business partners.
Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks.
Knowledge of Microsoft Office Suite as well as other business-related software.
Ability to work independently.
Registered nurse RN with 3-5 years clinical experience (orthopedic, occupational, neurological, neuromuscular, ICCU or industrial). Certified Case Manager Designation a plus.
2 openings. Telecommuting is allowed.
Additional Salary Information: Salary based on experience and PT/FT status
We are an independent privately owned case management firm. We provide medical case management and vocational placement services to individuals who have been injured while working. Additional services available through CCM include case management for elders and others with special needs.