Nurse Case Manager
POSITION SUMMARY
Supports the claims adjuster's management of files through application of medical expertise and case management principles by coordinating medically necessary and cost-effective medical treatment and services with a focus on an early and safe return to work.
DUTIES AND RESPONSIBILITIES
Initiates injured worker, attorney, health care provider and employer contacts within protocols.
Develops, implements and manages the medical and disability plans, and initiates appropriate and timely case management interventions.
Implements and coordinates services with the injured worker, family and health care providers during case management phase and documents all case management activity.
Obtains necessary information for purposes of facilitating the treatment plan and managing case progression.
Authorizes medically necessary, evidence-based and cost-effective treatment.
Coordinates services and resources necessary to expedite return to work.
Acts as a resource by review of claims with all relevant parties, such as Claims, Health Services and Legal.
Utilizes and monitors preferred vendors for select services to ensure prompt, cost effective service.
Follows established precertification and utilization review policies and protocols.
Acts as medical resource to peers, claims and legal personnel.
Supports Health Services Departments to ensure optimal service delivery to all customers.
Provides specialized case management services such as catastrophic case management or similar type roles.
Pursues and participates in continual educational activities for self-development and in meeting all regulatory requirements.
Responsible for delivery of customer service, exceeding expectations.
SKILLS, EDUCATION AND EXPERIENCE
Maryland RN License required.
Bachelor’s Degree (BSN) preferred.
Case management/utilization review experience preferred.
Prior workers’ compensation case management experience preferred.
3-5 years’ experience in nursing.
Workers Compensation Case Management (WCCM) and Maryland Certified Rehabilitation Service Practitioner (MCRSP) certification preferred.
Certified Case Manager (CCM) is preferred.
Strong interpersonal skills.
Familiarity with Windows, Word, Excel.
POSITIONAL COMPETENCIES
Bias for Action
Knowledge Sharing
Deliver Results
Service and Sales Excellence
Personal Leadership
Teamwork and Communication
PHYSICAL DEMANDS
While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include, close vision, peripheral vision and the ability to adjust focus.
WORK ENVIRONMENT
Office Environment. The noise level is usually moderate.