Workers' Compensation Case Manager

ExamWorks Clinical Solutions is searching for a Workers' Compensation 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 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 Workers' 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 Workers' 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.

• 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.

#LI-HP1

EDUCATION AND/OR EXPERIENCE

• Current, active, and unrestricted licensure as a health professional (RN)
• 5 years case manager experience preferred; 2 years case managment experience required.
• CCM preferred.

QUALIFICATIONS 

• Knowledge of the disability and workers' compensation industry ideal.
• Practice case management within the scope of his/her licensure (based on the standards of the discipline).
• 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.
• Knowledge of current laws and regulations that govern delivery of rehabilitation services.
• Must possess a valid driver’s license.
• Must provide proof of personal automobile liability insurance with liability limits of no less than Five Hundred Thousand and No/100 Dollars ($500,000.00) per occurrence.
• Must be able to operate a vehicle and have the ability and willingness to travel for task and/or field case management visits within assigned geographic areas.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Bilingual in English and Spanish preferred.