Nurse Consultant Telephonic Case Management

Gallagher • Jacksonville, FL

1d • Remote

About The Position

Provides medical management to workers compensation injured employees. Performs case management through telephonic contact with all medical providers, employers, claims professionals and ancillary service providers. Manage medical care in order to return injured employee to preinjury status. Reviews services of medical and rehabilitation providers and arranges for and coordinates appropriate evaluation, treatment, and counseling. Communicates with physician, injured worker, employer, referral source, and any other resource involved in worker's rehabilitation program. Evaluates home care services and equipment and determines need for home modifications. Coordinates home care. Communicates with employers to determine job requirements of pre-injury occupation and to explore light-duty, modified, or alternate employment as necessary. Analyzes results of treatment and medical status and reviews incoming provider reports. Identifies suitable employment opportunities consistent with individual's medical limitations/capabilities, aptitudes, and interests to restore individual to maximum independence. Generates reports to referral source to communicate case status, findings, and recommendations. Generates correspondence to referral source, medical providers, injured worker and other parties involved in the rehabilitation process. Participates in case conferences over the telephone, and participates in internal and external training to enhance and maintain medical proficiency. Documents case management observations, assessment, and plan in system. Must maintain a case load to support at minimum 145 hours of billable or inventory of minimum of 72 files monthly with 95% Quality compliance expected.

Requirements

• Degree from applicable program of training
• A minimum of 3 years clinical experience in an acute care setting required.
• Active Registered Nursing license or equivalent within the state of practice or states in which CM is performed.
• Demonstrates adequate knowledge of managed care with emphasis on use of criteria , guidelines and national standards of practice.
• Demonstrates good written and oral communications, organizational and leadership skills.
• Computer literate.
• Demonstrates good time management skills.
• Self starter.

Nice To Haves

• Bachelor's degree preferred.
• Worker's Compensation experience is preferred.
• Certification in related field preferred.

Responsibilities

• Provides medical management to workers compensation injured employees.
• Performs case management through telephonic contact with all medical providers, employers, claims professionals and ancillary service providers.
• Manage medical care in order to return injured employee to preinjury status.
• Reviews services of medical and rehabilitation providers and arranges for and coordinates appropriate evaluation, treatment, and counseling.
• Communicates with physician, injured worker, employer, referral source, and any other resource involved in worker's rehabilitation program.
• Evaluates home care services and equipment and determines need for home modifications.
• Coordinates home care.
• Communicates with employers to determine job requirements of pre-injury occupation and to explore light-duty, modified, or alternate employment as necessary.
• Analyzes results of treatment and medical status and reviews incoming provider reports.
• Identifies suitable employment opportunities consistent with individual's medical limitations/capabilities, aptitudes, and interests to restore individual to maximum independence.
• Generates reports to referral source to communicate case status, findings, and recommendations.
• Generates correspondence to referral source, medical providers, injured worker and other parties involved in the rehabilitation process.
• Participates in case conferences over the telephone, and participates in internal and external training to enhance and maintain medical proficiency.
• Documents case management observations, assessment, and plan in system.
• Must maintain a case load to support at minimum 145 hours of billable or inventory of minimum of 72 files monthly with 95% Quality compliance expected.

Benefits

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave
• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree