Case Manager

Role Overview

• Perform initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client’s situation for psychosocial needs, cultural implications and support systems in place
• Create 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
• Evaluate need for alternative treatment
• Negotiate appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards
• Negotiate and coordinate a prompt return to work with employer
• Measure 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
• Provide case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery
• Communicate effectively with handling claims examiner, client, claimant, attorney and supervisor
• Maintain 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

Benefits

• Three Medical plans
• Two dental plans
• 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