Position Overview
The Telephonic Nurse Case Manager will manage assigned occupational injury cases under the direction of the Medical Director and/or Director of Nurse Case Management.
Key Responsibilities
· Performs initial history of injured worker via telephone interview. Initial telephone contact attempted within 2 Business Days of case assignment and, if needed, non-contact letter mailed within 5 Business Days of case assignment.
· Reviews injured worker’s records and enters the summary into the database including details of the injury, past medical history, physical exam, diagnosis, treatment, pertinent laboratory/ x-ray findings, medications, next follow-up appointment and any other relevant information.
· Confers with the Medical Director, Supervisor or refers to Standing Orders on all new cases.
· Confers with the Medical Director, Supervisor or Standing Orders on all proposed treatment plans, specialist referrals, surgery requests, treatment requests, or other decisions outside of licensure.
· Coordinates specialist referrals with injured worker, employer, Specialist and adjuster. Documents Reimbursement Agreements on Authorization Letters for all Specialists who have a signed Provider Service Agreement on file with and forwards a copy to the adjuster.
· Ensures contact with the injured worker after any appointment or procedure to determine medical status and/or outcome. Demonstrate progress on every case assigned at least every 30 days.
· Ensures any medical reports are forwarded to all responsible parties.
· Requests medical records from all sources which the injured worker has been treated for the injury/condition. Requests signed HIPAA from adjuster and sends with Medical Records request to all prior medical providers.
· Answers questions and provides directions to injured workers regarding medical treatment within scope of licensure.
Performance Expectations
· Maintain accurate, timely and thorough documentation of all claimant interactions.
· Communicate effectively and professionally with the team.
· Participate in regular team meetings.
· Maintain a confident, caring and professional demeanor with all injured workers and clients.
· Adheres to all federal and state laws regarding release of medical information.
· Maintains regular and predictable attendance. Routinely works an 8-hour day. Maintains accurate timekeeping records
· Attendance at all Employee meetings
· Complete training requirements within scheduled timeframe
Required Skills and Qualifications
· Exceptional organizational skills are needed. Routinely utilizes Diary to ensure timely follow up on cases. Maintains accurate and timely entry of activity into injured worker’s file via database
· Excellent interpersonal skills, communication (written and verbal) and active listening skills.
· Strong organizational skills and ability to multitask.
· High level of empathy and compassion.
· Strong computer skills.
· Ability to work independently and maintain strict confidentiality (HIPAA compliance).
Education and Experience
- Completion of nursing school program and continuing education requirements to maintain certification
- Must be licensed in state where case management services are provided.
- Practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline
- Prior experience in patient navigation, care coordination, case management.
- Two years full-time equivalent providing direct case management to the injured worker or work under a supervisor for two years preferred
Performance Metrics
Performance will be measured based on the following KPIs:
- Consistently meet or exceed expected performance set forth by the Director of Nursing
Work Environment & Location
- Remote/hybrid
- Reports to: Director of Nurse Case Management.
Benefits
- Competitive pay and bonus program
- Health, dental, vision, and retirement plans
- Flexible scheduling
- Nurse referral program
- Continuing education support
