Job Description

The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker’s compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risks on behalf of the Company. Essential duties include creating and managing worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process; performing initial and ongoing clinical assessment via telephone calls to relevant parties including injured worker, physician, attorney or others; assessing client's psychosocial needs and cultural implications; creating case management plans with measurable goals using evidence-based criteria; monitoring progress; implementing plans through interventions and communication; measuring treatment effectiveness and recommending alternatives; negotiating care level and disability duration with providers; coordinating return to work with employer; measuring and reporting on interventions including clinical, financial, and client satisfaction outcomes; maintaining accurate records; communicating effectively with all parties; providing case direction to field specialists; maintaining privacy and confidentiality; interfacing with external agencies for utilization review; and possibly performing utilization review activities. The role requires an Associate's or Bachelor’s degree in Nursing preferred, minimum 2 years clinical care experience, current unrestricted RN or LVN license, and preferably certification in case management or related specialty. Skills include clinical care knowledge, ability to work with medical and mathematical concepts, logical and sound judgment, problem-solving, document analysis, and effective communication. Physical requirements include frequent sitting, standing, walking, reaching, occasional lifting up to 30 pounds, and visual acuity for computer use. The work environment is office-based with frequent computer and telephone use and occasional travel. No employment sponsorship is offered. Salary range is $78,678.61 - $132,686.15, exclusive of benefits and bonuses, with final compensation based on experience, education, and location.

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