RN, telephonic Clinical Case Manager

Managed Medical Review Organization•Novi, MI

5d•Remote

About The Position

We are looking for an experienced RN Clinical Case Manager to support a disability claim review program. In this role, you will guide members through a collaborative case management process built on assessment, planning, care coordination, and ongoing evaluation. Your work directly supports improvement in members' (patients) disabling and co-morbid conditions and helps maximize their employability. You will own your caseload from start to finish and be responsible for an efficient, timely, and complete case management process.

Requirements

Unrestricted RN licensure, without sanctions.
Current certification in case management or a related field, or the ability to qualify for certification testing within six months of hire.
Minimum of five years of clinical experience.
Minimum of five years of case management experience in one or more of the following: medical, workers' compensation, auto, or disability case management.
Working knowledge of diagnostic coding (ICD-10).
Strong critical thinking, decision-making, and organizational skills with close attention to detail.
Ability to meet deadlines and turnaround times consistently.
Ability to work independently as well as within a team.
Computer literacy, including solid working knowledge of Microsoft Word and Excel.
Strong written, verbal, and telephonic communication skills, with the ability to manage multiple priorities.
Bachelor's degree in nursing or a health-related field.
Working knowledge of the insurance industry, medical claims, and/or disability claims.

Nice To Haves

Experience with Lean production management.

Responsibilities

Determine the appropriate case management track for each assigned case.
Conduct telephonic clinical assessments covering activities of daily living, psycho-social factors, recent hospitalizations, current clinical status, treatment plans and medications, treating physicians, special needs, and the appropriate outreach interval for each case.
Develop customized, member-specific clinical case management plans.
Perform ongoing periodic telephonic outreach at intervals set during the initial clinical assessment.
Request and track receipt of the records and documentation needed to identify ongoing case management needs.
Build and maintain a case management resource library to provide members with information relevant to their conditions.
Assess whether a review is needed for a member's return to their own occupation, and identify the appropriate physician specialty when it is.
Collaborate with vocational specialists during the case management process when needed.
Conduct thorough, ongoing quality review of all case documentation and ensure completeness and accuracy of case paperwork.
Communicate with members, physicians, employers, and clients as appropriate.
Enter case activities into the case management system accurately and within client-required timeframes.
Maintain compliance with applicable practice standards and guidelines, including strict confidentiality and HIPAA adherence.