Field Nurse Case Manager - Raleigh, NC

Gallagher•Raleigh, NC

About The Position

Provides medical management to workers’ compensation injured employees through case management conducted by telephone and in-person contact with injured workers and medical providers. Coordinates with employers and claims professionals to manage medical care and support the injured employee’s return to work. The position covers the Raleigh, North Carolina area, with a travel radius of up to two hours. The case manager coordinates medical evaluation and treatment, collaborates with physicians and injured workers on treatment plans and return-to-work goals, and communicates medical treatment and work status to employers and referral sources. The role also coordinates ancillary services, documents case observations and plans, and provides case-status reports and ongoing correspondence to participants in the injured worker’s treatment. The position carries a minimum caseload of 35 files and a target of 150 monthly billable hours, with minimum 95% quality compliance.

Requirements

Degree from an applicable program of training.
Minimum of 3 years of clinical experience in an acute care setting.
Active Registered Nursing license or equivalent in the state of practice or states where case management is performed.
Demonstrated knowledge of managed care, including use of criteria, guidelines, and national standards of practice.
Advanced written and oral communication skills.
Organizational and leadership skills.
Ability to self-direct and proactively manage assigned case files.
Strong time management skills.
Ability to travel to appointments within approximately a two-hour radius.

Nice To Haves

Bachelor’s degree.
Workers’ compensation experience.
Certification in a related field.
1–3 years of clinical experience.

Responsibilities

Coordinate medical evaluation and treatment.
Meet with physicians and injured workers to collaborate on treatment plans and discuss return-to-work goals.
Keep employers and referral sources updated regarding medical treatment and work status.
Coordinate ancillary services, such as home health, durable medical equipment, and physical therapy.
Communicate with employers to determine job requirements and explore modified or alternate employment.
Discuss and evaluate treatment-plan results with physicians and injured workers using Evidence Based Guidelines to support effective outcomes.
Document case management observations, assessments, and plans.
Generate reports for referral sources communicating case status and recommendations.
Prepare ongoing correspondence for referral sources, employers, medical providers, injured workers, and other participants in the treatment plan.
Participate in telephonic case conferences as needed.
Maintain a minimum caseload of 35 files and 150 monthly billable hours, with minimum 95% quality compliance.