Telephonic Nurse Case Manager

2 weeks ago

CA United States Pinnacle Case Management Solutions, LLC. Full time

Company Description

Pinnacle Case Management Solutions, LLC provides nurse case management services to employers, third-party administrators, and insurance carriers in the Workers' Compensation industry. Our dedicated team of nurses support all parties involved in the recovery process, including the claim examiner, employer, provider, and injured worker. We are committed to being available 24/7 to ensure the highest level of care and assistance.


Position Summary

Pinnacle Case Management Solutions has an immediate need for a full-time, Telephonic Nurse Case Manager. The Telephonic Nurse Case Manager will be responsible for day-to-day tasks including communicating accurately, timely, professionally, and comprehensively with injured workers, claims adjusters, attorneys, employers, providers, clinics, and other parties with information relevant to a claim. The Telephonic Nurse Case Manager researches and recommends resources and creates flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate. This position is located remotely from California.


Essential Position Requirements

  • Nurse Case Management skills in the Workers' Compensation industry
  • Bilingual: English and Spanish
  • Active LVN or RN license from any US state required at time of hire
  • Excellent communication and interpersonal skills
  • Ability to work collaboratively and independently
  • Strong organizational and time management skills
  • Identifies actual and potential delays in service requests or treatment and communicates them to the team so steps can be taken to eliminate or minimize delays
  • Communicates accurately, timely, professionally, appropriately, and comprehensively with injured workers, claims adjusters, attorneys, employers, providers, clinics, and other parties with information relevant to a claim, via phone, email, U.S. mail, fax, or virtual meeting


Primary Responsibilities

  • Maintains constant contact with the adjuster assigned to the file through telephone calls, email, and written reports.
  • Organizes and reviews medical records to identify specific medical issues; Provides information and recommendations to appropriate parties.
  • Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services.
  • Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations).
  • Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
  • Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
  • Works with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved.
  • Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports.
  • Develops Independent Medical Evaluation Plan. Provides assessment, planning, implementation, and evaluation of patient's progress
  • Facilitates authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed.
  • Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim. Works with the treating physician to update any conditions as medical treatment progresses
  • Assesses the injured worker and his/her support system and family. Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
  • Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment, ensuring the job is consistent with any physical restrictions assigned by the treating doctor.
  • Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force.


Apply With Us

We look forward to learning about YOU If you believe in our core values commitment to service and results and a caring family culture, we invite you to apply with us.


Thank You

We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated.


Salary

  • Range: $80,000 - $120,000 per year

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