Bilingual Telephonic Nurse Case Manager

Athens Administrators•San Antonio, TX

18h•Remote

About The Position

Athens Administrators has an immediate need for a full-time Telephonic Nurse Case Manager to support our Managed Care Department. The position can be located remotely from California, Colorado, Nevada, Texas, Oregon, Idaho, Arizona, or Oklahoma if technical requirements are met. This position will work M-F from 9am to 5pm Pacific time schedule regardless of time zone. The Telephonic Nurse Case Manager researches and recommends resources and creates flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate. This position will assist the unit in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training.

Requirements

A Master's or Bachelor's degree in nursing or an Associate's Degree in Nursing from an accredited school, along with equivalent work experience, is required
Active RN license from any US state required at time of hire
Current RN licensure in CA required within one year of hire (if not already obtained)
California RN application submitted within the first two weeks of hire.
3+ years’ workers’ compensation case management experience or related field required
Fluency in Spanish required
Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.
Strong negotiation skills
The ability to work effectively with minimal direct supervision
Well-developed verbal and written communication skills with strong attention to detail
Excellent organizational skills and ability to multi-task
Ability to type quickly, accurately and for prolonged periods
Ability to use a computer mouse, touchpad, or other input device frequently and for prolonged periods.
Proficient in Microsoft Office Suite
Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.

Nice To Haves

CCM, CIRS, CRRN, COHN or other related designation preferred
Master’s or Bachelor’s degree in related field with a CCM, CDMS, or CRC or other related designation preferred
Strong clinical background in orthopedics, neurology, or rehabilitation useful
Strong cost containment background, such as utilization review or managed care also useful

Responsibilities

Organizes and reviews medical records to identify specific medical issues; Provides information and recommendations to appropriate parties.
Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services.
Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations).
Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made.
May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved.
Obtains medical reports and required work status forms.
Ensures all parties receive appropriate reports.
Develops Independent Medical Evaluation Plan.
Provides assessment, planning, implementation, and evaluation of patient's progress
Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed.
Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim.
Work with the treating physician to update any conditions as medical treatment progresses
Assesses the injured worker and his/her support system and family.
Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment, ensuring the job is consistent with any physical restrictions assigned by the treating doctor.
Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force.
Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan.
Research medical and community resources for patients with catastrophic or chronic diagnoses, such as but not limited to, AIDS, cancer, spinal cord injury, diabetes, head injury, back injury, hand injury, burns, et cetera.
Maintains constant contact with the adjuster assigned to the file through telephone calls, email, and written reports.
For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits.
Satisfy the documentation and reporting requirements of each customer.
Maintains continuing education requirements per state license requirements.
Maintains an updated and working knowledge of workers’ compensation and federal laws that impact the delivery of health care and return to work
May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
Assist the overall unit with development of workflows, best practices, reporting templates, and training needs as deemed necessary.
Requires regular and consistent attendance
May be asked to travel to other branches for training or file reviews as needed.
Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)