Telephonic Nurse Case Manager
| Company | ICW Group |
|---|---|
| Location | Las Vegas, NV, USA, Orlando, FL, USA, Canoga Park, Los Angeles, CA, USA, Pleasanton, CA, USA, Philadelphia, PA, USA, Downers Grove, IL, USA, Sacramento, CA, USA, San Diego, CA, USA |
| Salary | $78678.61 – $132686.15 |
| Type | Full-Time |
| Degrees | Bachelor’s, Associate’s |
| Experience Level | Junior, Mid Level |
Requirements
- Associate’s or Bachelor’s degree from four-year college or university in Nursing preferred
- Minimum 2 years of professional experience providing direct clinical care required
- Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required
- Certification in case management, rehabilitation nursing or a related specialty is strongly preferred
Responsibilities
- Creates and manages worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process
- Performs initial and ongoing clinical assessment via telephone calls to relevant parties that may include the injured worker, physician, attorney or other parties
- Assesses client’s situation for psychosocial needs, cultural implications and ensures support systems are in place
- Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria
- Monitors ongoing progress toward established goals and objectives
- Implements plan through case management interventions and communication with all parties to reach desired goals and objectives
- Measures effectiveness of treatment plans and creates alternate strategies when needed
- Recommends need for alternative treatment plans using systematic and objective procedures set by the Company
- Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards
- Negotiates and coordinates a prompt return to work with employer
- Measures and reports on interventions to determine the outcome of the case manager’s involvement to include clinical, financial, variance, quality of life, and client satisfaction
- Maintains accurate record of management including costs, savings and demographic data
- Communicates effectively with all parties involved in injured worker’s treatment
- Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery
- Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case
- Maintains injured worker’s privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards
- Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers
- May perform Utilization Review activities (or review information coming through a vendor partner); presents reports to clients and providers
Preferred Qualifications
- Certification in case management, rehabilitation nursing or a related specialty is strongly preferred