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RN Case Manager

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One to One Health RN Case Manager

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Job Description: Occupational Health Case Manager

Company: One to One Health (Rivian Health Hub)

Location: Normal, IL

Job Type: Full-Time

Reports to: Practice Manager

Job Summary

Rivian Health Hub is seeking a dedicated, organized, and proactive Workers' Compensation Case Manager to join our occupational health team. The Case Manager is the central point of communication for an injured employee's case, acting as a liaison between the patient, employer, insurance carrier, and our clinical team. The primary goal of this role is to facilitate the patient's optimal medical recovery and ensure a safe, timely, and cost-effective return to work.

The ideal candidate will be an exceptional communicator with a strong understanding of workers' compensation processes and medical terminology, dedicated to providing excellent service and achieving positive outcomes for all stakeholders.

Key Responsibilities

Case Coordination: Serve as the primary point of contact for all parties involved in a workers' compensation claim, including the injured employee, Rivian leadership & EHS staff, insurance adjusters, and medical providers.
Communication: Proactively communicate case status, treatment plans, and work-status updates to all relevant parties.Ensure clear, concise, and timely dissemination of information.
Treatment Plan Management: Collaborate with physicians, physical therapists, and other healthcare providers to understand and manage the patient's treatment plan. Schedule appointments, specialist referrals, and diagnostic tests as required.
Return-to-Work (RTW) Program: Implement, and monitor return-to-work plans, including coordinating modified or light-duty assignments with Rivian Leadership. Actively identify and address any barriers to a successful RTW.
Authorization & Utilization Review: Obtain necessary authorizations for treatment from insurance carriers. Provide clinical information to support the medical necessity of care and facilitate the claims process.
Documentation: Maintain meticulous, accurate, and confidential case records within the Electronic Medical Record (EMR) system. Document all communications, actions, and progress notes related to each case.
Regulatory Compliance: Ensure all case management activities adhere to state-specific workers' compensation laws, HIPAA regulations, and company policies.
Patient Advocacy & Education: Educate injured employees about the workers' compensation process, their treatment plan, and their role in recovery to empower them and alleviate concerns.
Case Closure: Monitor cases through to completion, ensuring Maximum Medical Improvement (MMI) has been reached and all necessary documentation for case closure is finalized and distributed.

Qualifications and Requirements

Required:

High school diploma or equivalent.
A minimum of 2-3 years of experience in a workers' compensation case management, claims adjusting, or a similar role within a medical or insurance environment.
Strong knowledge of state workers' compensation laws and regulations.
Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience working with Electronic Medical Record (EMR) systems.
Excellent verbal and written communication skills, with the ability to communicate effectively with individuals at all levels.

Preferred:

Associate's or Bachelor's degree in Nursing, Healthcare Administration, Business, or a related field.
Clinical background or certification (e.g., RN, LPN, MA, CCM - Certified Case Manager).
Experience working directly within an occupational health or orthopedic clinic setting.
Bilingual in English and Spanish is highly desirable.
Familiarity with medical terminology, particularly related to musculoskeletal and workplace injuries.

Skills and Competencies

Organizational Skills: Superior ability to manage multiple cases simultaneously, prioritize tasks, and meet deadlines in a fast-paced environment.
Attention to Detail: Meticulous approach to documentation and communication to ensure accuracy.
Interpersonal Skills: Ability to build strong, professional relationships with patients, clients, and colleagues. Demonstrates empathy, patience, and active listening.
Problem-Solving: Strong critical thinking and analytical skills to navigate complex cases, identify barriers, and develop effective solutions.
Professionalism: Maintains a high level of confidentiality and professional conduct at all times.
Team Player: Works collaboratively with the clinical and administrative teams to achieve clinic goals.

Work Environment

This position operates primarily in a professional office environment within a medical clinic. This role routinely uses standard office equipment such as computers, phones, and photocopiers.