| | Description: GENERAL SUMMARY: This is a part time position that provides case management in order to promote efficient coordination of client care through collaborative practice within the healthcare systems and multiple environments. ESSENTIAL JOB FUNCTIONS: - Assess, plan, implement, coordinate participate, monitor and evaluate treatment plan by physician/healthcare team/providers. This may require on-site visits with the claimant and health care team.
- Establish positive relationships with claimant, employer, TPA’s, carriers, attorneys, community resources, physicians and other health care providers.
- Identify, assess, plan, implement, coordinate, monitor and evaluate cost effective medical care alternatives.
- Advocate for client in order to ensure quality outcomes.
- Provide carriers’ with concurrent review information as needed to comply with carriers’ requirements for documentation of medical necessity and negotiates resolution of any disagreement over the need for services.
- Coordinate return to work and monitor client’s progress. Discuss and recommend job modifications as necessary. This may require the completion of on-site job analysis or involvement with ergonomics.
- Document all interactions and outcomes related to claim.
- Maintain the dignity and confidentiality of the client and all verbal/written information/communication.
- Client and family members regarding the Worker’s Compensation system,
- Members of the healthcare team on managed care requirements and their implications,
- Patient care and health care providers on the concept, process and goals of case management.
- Refer to voc as appropriate
Requirements: KNOWLEDGE SKILLS & ABILITIES: Knowledge of managed care mandates and case management Strong Communication skills; oral and written
Ability to multi-task Time management skills Strong facilitation and team building skills Ability to work independently Ability to interact with multidisciplinary teams in an assertive yet sensitive manner. EDUCATION & EXPERIENCE: Graduate of an accredited school of nursing. RN, BSN or RN with a Bachelors degree in a health related field CCM preferred Licensure: Current license as a Registered Nurse in the state they will be working in.
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