Telephonic Case Manager

Role Overview

• To perform initial and ongoing clinical assessment and evaluate need for alternative treatment.
• Negotiate and coordinate appropriate medical treatment and length of disability with providers and employers.
• Implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
• Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• Monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
• Evaluates need for alternative treatment.
• Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
• Negotiates and coordinates a prompt return to work with employer.
• Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.
• Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
• Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.
• Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.

Requirements

• Current unrestricted RN license(s) in a state or territory of the United States required.
• Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
• Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
• Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of fulltime equivalent providing direct clinical care to the consumer.
• Knowledge of workers' compensation laws and regulations.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Leadership/management/motivational skills.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent interpersonal skills.
• Excellent negotiation skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Benefits

• Three Medical, and two dental plans to choose from.
• Tuition reimbursement eligible.
• 401K plan that matches 50% on every $ you put in up to the first 6% you save.
• 4 weeks PTO your first full year.