Telephonic Nurse Case Manager

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

Job Type: Full-time Pay: From $75,000.00 per year Benefits:

• 401(k)
• Continuing education credits
• Dental insurance
• Free parking
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

License/Certification:

• Maryland WCCM (Required)

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