Case Manager Jobs

About The Position

Requirements

• Possess excellent communication and organizational skills to interface with the client, claimants, and staff.
• Work well independently and set priorities.
• Current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN) and or Certified Case Manager (CCM) license required
• Three or more years of diverse clinical experience in acute care
• Two or more years of medical case management or managed care experience, Worker’s Compensation background preferred
• Knowledge of utilization management, quality improvement, discharge planning, and or cost management.
• Ability to solve practical problems and deal with a variety of variables.
• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
• Excellent interpersonal skills and excellent organizational skills.
• Ability to set priorities and work independently is essential
• Proficient with Microsoft Office applications including Word, Excel, and PowerPoint

Nice To Haves

• Master’s level (or higher) in a Nursing, Health or Human Services field or equivalent related experience preferred
• CCM, CMCN, CPHUR, CPDM, COHN or CDMS certification preferred

Responsibilities

• Provide telephonic outreach for assessment, and follow up for case communication and coordination to include assessing, planning, implementing, coordinating of care
• Conducts and documents initial assessment with the injured worker, employer and provider and maintain regular contact with all parties involved to facilitate communication and to formulate a clinical case plan
• Responsible for coordination of contact with provider, claimant, RTW contact and claims examiner
• Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services
• Assessment of medical records for appropriateness of treatment and level of care being provided.
• Referral to the Medical Director if appropriate within the established timeframes
• Facilitate timely return to work date coordinating RTW with the claimant, employer and physicians
• Maintains contact and communicates updated activity with all parties involved with the case
• Telephonically monitor medical appointments of the injured worker to address RTW, current treatment plan and identify potential issues and promote positive treatment outcomes.
• Negotiate treatment plan with treating physician
• Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
• Maintain minimum billing and established template documentation standards adhering to URAC standards and company policy and procedures
• Reporting billing hours in accordance with case activity and billing practices
• Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI
• Other job duties as assigned

Benefits

• Medical, Dental, Vision Insurance.
• Life and Disability Insurance.
• 401(k) Plan
• Paid Holidays
• Paid Time Off.
• Referral bonus.