About the job
Job Summary
As a dedicated Nurse Case Manager, you will play a crucial role in coordinating comprehensive care and effectively communicating vital medical information among the Injured Worker, the Insured, and the Carrier. Your expertise will facilitate appropriate treatment, promote successful rehabilitation, and support the return to work. This position emphasizes efficient and cost-effective communication concerning work injuries, motor vehicle accidents (MVAs), liability claims, long-term disability (LTD), short-term disability (STD), and other associated services. This role is predominantly field-based, requiring regular local travel within a 2-hour radius of your region.
Duties & Responsibilities
- Adhere to all policies and procedures outlined in the Case Management (CM) plan, taking full accountability for the CM process.
- Receive and manage referrals as directed by the Director of Case Management.
- Initiate contact according to the CM plan; schedule initial assessments; and ascertain the date of the next physician appointment.
- Confirm assignments with referral sources and clarify any special handling instructions.
- Establish and nurture professional relationships with clients, ensuring claimants are treated with respect and dignity.
- Following physician appointments, communicate with the Carrier and Insured in accordance with protocols; maintain ongoing contact with the Injured Worker, the Insured, and the Carrier.
- Document data and billing in CaseAnyplace; ensure timely submission of monthly reports (Preliminary, Initial, Progress, Closing).
- Attend physician appointments to gather diagnosis, prognosis, treatment plan, expected rehabilitation length, estimated return-to-work (RTW) status (modified/regular duty), and Maximum Medical Improvement (MMI)/Full Recovery as relevant.
- Coordinate referrals to a Vocational Counselor for job analyses (modified/regular duty) when appropriate and approved by the Carrier.
- Recommend Independent Medical Examination (IME) physicians and facilitate attendance at IMEs.
- Coordinate transportation arrangements as necessary.
- Provide translation services as required (for bilingual nurses).
- Monitor treatment plans; attend therapy sessions as appropriate; and maintain communication with therapists for updates.
- Request file transfers to the Vocational Counselor when necessary (LMS, Voc Rehab).
- Assist the Carrier/Insured with RTW planning (modified or regular duty).
- Provide relevant information to Defense Attorneys as required.
- Foster teamwork and collaboration among all staff members.
- Maximize the accuracy and appropriateness of billable hours to meet monthly targets (8 hrs/day).
- Maintain licensure and certification...
