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Field Nurse Case Manager (RN)

Field Nurse Case Manager (RN)

Job Description

We are currently seeking a Field Nurse Case Manager (RN) in the Southern Philadelphia/Delaware County area

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.
• Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists.
• 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.
• Acquireing 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.

Job Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Diploma, Associate or bachelors degree in nursing or bachelors degree (or higher) in a health or human services related field required. Masters level and/or advanced study in a health-related field desired.
• Minimum of two (2) years full time equivalent of direct clinical care to consumers required. Case Management and/or Workers’ compensation-related experience strongly preferred.
• Registered nurse with current, valid state licensure required.
• Must be eligible to sit for CCM certification and must have a valid driver’s license.
• Experience in rehabilitation services industry, vocational/ occupational/ industrial nursing preferred.
• Background in state workers’ compensation law and practices desirable.
• In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of the persons being served, that requires:
1) A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization;
2) The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and
3) URAC-recognized certification in case management within four (4) years of hire as a case manager
• Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility.
• Excellent interpersonal skills and phone manners. Excellent organizational skills.
• Must be proficient in Microsoft Office suite with such programs as Word and Excel as well as have experience with internet searches and a comfort level with other software programs.
• Ability to set priorities and work independently is essential.
• Spanish speaking ability a plus!

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services, Insurance, Managed Care
Required Travel Not Specified
Job ID 1065
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Field Nurse Case Manager (RN)


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