We are currently seeking a Medical Nurse Case Manager (RN) for the San Antonio area (Bilingual Eng/Spanish-speaking and certified in case management a plus), to include surrounding towns i.e. Del Rio, Laredo, Kerrville, New Braunfels.
Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured worker and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.
Main responsibilities will include but are not limited to:
•Using clinical/nursing skills to help coordinate the individual's treatment program while maximizing cost containment.
•Explaining physician's and therapists' instructions, and answers any other questions the claimant may have in an effort to facilitate his/her return to work.
•Working with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator's guidelines.
•Researching alternative treatment programs such as pain clinics, home health care, and work hardening.
•Coordinating all aspects of the individual's enrollment into the programs, and then monitors his/her progress, in an effort to maximize cost containment and minimize time away from work.
•Working with employers on modifications to job duties based on medical limitations and the employees functional assessment.
•May provide testimony on litigated cases.
•Coordinating injured workers' appointments and arranges and/or personally escorts him/her to the appointments.
•Documenting and reporting all case activity for accurate case management and billing procedures.
•Preparing detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed.
•Reporting billing hours in accordance with case activity and billing practices.
•Maintaining phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.
•Compiling a case inventory on a monthly basis for submission to the branch manager to allow for proper billing and to calculate hours for bonus purposes.
•Completing insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies.
•Maintaining the necessary credentials and demonstrates a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole.
•acquiring and maintaining knowledge of developments in the medical case management field.
•Keeping abreast of local workers' compensation laws and regulations, as well as other issues related to the case management/managed care industry.