• Nurse Case Manager

    Requisition ID
    2018-3546
    # of Openings
    1
    Category
    Operations
    Location
    US-TX-Longview
  • Overview

    The Nurse Case Manager is responsible for assessing, planning, implementing, coordinating, reassessing, and evaluating case management activities associated with an injured individual. This position will evaluate the medical and disability needs of the injured individual, facilitate timely return to work and assist in the coordination of quality healthcare services as necessary to meet an individual’s specific health care needs in the most cost effective manner.  This position acts as a liaison with the Field Case Manager, patient and family, employer, provider(s), insurance companies and any healthcare personnel.

    Responsibilities

    • Works with employees, employers, providers and claim handlers to coordinate and assure proper delivery and oversight of medical and disability services.
    • Utilize clinical/nursing skills to collect, review and analyze health data from medical records and/or other sources as provided.
    • Assists the injured employee by providing medical and disability education and coordinates on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations.
    • Negotiates and assists the employers with the development of transitional sedentary or modified job duties based on the injured patients’ functional capacity to accommodate employees to a safe and timely return-to-work.
    • Evaluates and coordinates medical and rehabilitative services using cost containment strategies.
    • Develops and promotes a positive and cooperative partnership with the customer.
    • Uses effective negotiation techniques for cost containment and early return-to-work.
    • Presents a courteous, helpful, professional manner to all callers.
    • Notifies management when it appears that communications will not be completed within specific time frames or for other case issues that require supervisory advice/decisions.
    • Adheres to Customer Special Account Instructions to include documentation requirements and turnaround times.
    • Adheres to all appropriate privacy, security, and confidentiality policies and procedures.
    • Participates in the mentoring of new employees, as assigned.
    • Actively participates as a contributing team member as demonstrated by attitude, cooperation, shared problem solving and participation in projects.
    • Gathers relevant data and information by conducting clinical interviews with the injured employee, the provider(s), and the employer.
    • Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care.
    • Plans a proactive course of action to address issues presented and enhances the injured employee’s short and long term outcomes.
    • Performs pre-certification process for prescribed treatment .
    • Facilitates and promotes timely and effective communication between all parties involved.
    • Works address treatment alternatives; coordination of quality, cost effective health care and rehabilitative services; and appropriate and timely return-to-work.
    • Assists the injured employee to achieve an optimal level of wellness and functioning, enhances the injured employee’s productivity during recuperation, and maintains the cost effectiveness of health care and expenditures of healthcare dollars.
    • Monitors and evaluates case management outcomes and identifies case management approaches; over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return-to-work, noncompliance, etc.
    • Acts as a strong problem solver utilizing analytical ability and demonstrating this competency through communication, organization and interpersonal skills.
    • Obtaining and maintaining applicable designations are encouraged; these designations are required where dictated by state regulations.

    Qualifications

    • Bilingual highly preferred.
    • RN License required.
    • 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.
    • Working knowledge of the Cost of Medical Care.
    • Must be able to utilize clinical knowledge and medical experience to make independent assessments of case severity, treatment needs and outcomes to give guidance and direction to claim staff.
    • Must be able to integrate clinical knowledge and understanding of disability programs to educate and guide claim staff on appropriate direction for future treatment.
    • Must be able to make independent assessments and formulate recommendations based on experience and training quickly and autonomously.
    • Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
    • Must have strong knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
    • Typing proficiency at a minimum of 30 WPM.
    • Demonstrates excellent customer service skills in a high demand business environment.
    • Must demonstrate effective communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
    • Must be able to work independently, prioritize work activities and use time efficiently.
    • Strong problem solving skills and ability to perform critical analysis.
    • Effective organizational skills and ability to perform multiple tasks simultaneously.
    • Ability to follow instructions and respond to managements’ directions accurately.
    • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
    • Must be able to maintain confidentiality.
    • Must be able to demonstrate team behavior and promote a team-oriented environment.
    • Must be able to work well under pressure and or stressful conditions.
    • Adapts to change in work environment with the ability to manage change, delays, or unexpected events.
    • Must maintain a professional and clean appearance at all times consistent with company standards.
    • Performs various professional duties as assigned by management.

     

    LANGUAGE/COMMUNICATION SKILLS

    • Ability to read and comprehend instructions, correspondence, and memos.
    • Ability to write correspondence and present information to customers, clients, and other employees of the organization

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