Nurse Consultant Telephonic Case Management

Gallagher•Little Rock, AR

About The Position

Provides medical management to workers compensation injured employees through telephonic case management. The role involves communicating with medical providers, employers, claims professionals, injured workers, referral sources, and ancillary service providers to coordinate care and support the injured employee's return to pre-injury status and maximum independence. The Nurse Consultant reviews treatment and rehabilitation services, coordinates evaluations and treatment, assesses home care and equipment needs, and helps identify suitable work consistent with the individual's medical limitations, capabilities, aptitudes, and interests. The position also analyzes treatment outcomes and medical status, reviews provider reports, prepares case-status reports and correspondence, participates in telephone case conferences and training, and documents case observations, assessments, and plans in the system. The incumbent must maintain a caseload supporting at least 145 billable hours or a minimum monthly inventory of 72 files, with 95% quality compliance expected.

Requirements

Degree from an applicable program of training.
At least 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.
Adequate knowledge of managed care, including use of criteria, guidelines, and national standards of practice.
Good written and oral communication, organizational, and leadership skills.
Computer literacy.
Good time management skills.
Self-starter.

Nice To Haves

Bachelor's degree.
Workers' Compensation experience.
Certification in a related field.

Responsibilities

Provide medical management to injured workers' compensation employees.
Perform telephonic case management with medical providers, employers, claims professionals, and ancillary service providers.
Manage medical care to help injured employees return to pre-injury status.
Review medical and rehabilitation provider services and coordinate appropriate evaluations, treatment, and counseling.
Communicate with physicians, injured workers, employers, referral sources, and other rehabilitation resources.
Evaluate home care services and equipment, determine the need for home modifications, and coordinate home care.
Determine pre-injury job requirements with employers and explore light-duty, modified, or alternate employment as needed.
Analyze treatment results and medical status and review provider reports.
Identify suitable employment consistent with an individual's medical limitations, capabilities, aptitudes, and interests.
Prepare reports and correspondence for referral sources, medical providers, injured workers, and other parties involved in rehabilitation.
Participate in telephone case conferences and internal and external training to maintain and enhance medical proficiency.
Document case management observations, assessments, and plans in the system.
Maintain at least 145 billable hours or a minimum monthly inventory of 72 files, with 95% quality compliance.