Medical Field Case Manager

Requisition ID
2017-2275
# of Openings
1
Category
Operations
US-TX-Longview

Overview

ExamWorks Clinical Solutions is searching for a Field Case Manager (RN Required). Registered Nurses are a key component in the healthcare industry. We understand that you have put in many tireless hours, overnights, and weekends providing compassionate care. Here is your opportunity to take off those scrubs and take back your life style. Goodbye working weekends, goodbye working holidays. It’s time to say hello to family time, work-life balance, and relaxation. As an RN with us, you will trade the chaotic clinical setting for a cozy office environment. Sounds too good to be true, but it isn’t! 

 

 

Let’s get down to what you can expect in your new RN position. Our Field Compensation Case Manager’s accept assignments from an employer, insurance company, or other responsible party regarding an injured or disabled individual. Once we have that information, you will begin to assess the information provided to determine the individual's specific health care needs in order to facilitate a timely return to work. Sounds easy enough. As a Field Compensation Case Manager (RN), your responsibility is to ensure that the patient is receiving quality care that is appropriate and necessary. In doing so, you will anticipate the patient's future health care needs and aid in ensuring the proper mechanisms are put in place to meet maximum rehabilitation in the most efficient and cost effective way possible. You will also develop and present treatment plans and secure provider acceptance to the plan.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

  • Assesses and analyzes injured worker's medical and/or vocational status and develops a viable, realistic action plan for maximum medical improvement from date of referral to closure.
  • Meets with individuals in their homes, work-sites, physician's or therapist's office to provide ongoing case management services.
  • Assesses the assigned individual to ensure appropriate safety measures are in place.
  • Implements, calculates and documents cost savings measures.
  • Manages progress towards desired outcomes.
  • Responsible for maintaining regular communication with the injured worker, medical providers, attorneys, employers, claims professionals, and ECS management.
  • Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care.
  • Applies all special service instructions required by customers/accounts.
  • Appropriately applies all laws and regulations to the provision of rehabilitation services.
  • As needed, testifies to substantiate any casework or reports that may be deemed relevant in litigated cases.
  • Evaluates outcomes and case goals.
  • Prepares reports and other required documentation for casework activities.
  • Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment.
  • Upholds applicable state and federal regulatory requirements that govern workers' compensation disability.
  • Substantiates case activities carried out/services rendered in all activity reports completed.
  • Accurately reports all case activity and billable hours in accordance with client-specific guidelines and consistent with company billing practices.
  • Meets weekly billing requirements (35-40 hours per week for full-time Case Managers).
  • Attends all scheduled conference calls as mandated by management.
  • Maintains any required credentials and adheres to all codes of ethics required by these credentials.
  • Performs various professional duties as assigned by management.

Qualifications

EDUCATION AND/OR EXPERIENCE

  • Associates Degree or Diploma in nursing is acceptable; a bachelor’s degree in nursing and/or health related field preferred.
  • Current, active, and unrestricted licensure as a health professional (RN).
  • 5 years case manager experience preferred.
  • Minimum 2 years clinical nursing background.
  • Knowledge of the disability and workers' compensation industry including rules and regulations and an understanding of clinical procedures and all processes involved in the delivery of quality health care to an injured worker.
  • Bilingual in English and Spanish ideal.  

At ExamWorks Clinical Solutions, we want our RN’s to act as a liaison between the patient, family, employer, provider(s), insurance companies and/or healthcare personnel. You should have great communication skills as you will be communicating all activities through written reports and verbal updates to the referring party. Since you have worked in a clinical setting, you know time is of the essence. We are responsible for timely service delivery and quality reporting in compliance with URAC Standards, and to represent ExamWorks Clinical Solutions in a professional and customer oriented manner.

In case you miss your scrubs you can always have a throwback Thursday and wear them to work!  Take back your quality of life and click apply today!

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