Clinical Case Manager

4 weeks ago

Bridgewater, United States Talent Solutions Group Inc Full time
Must have Nurse, Nurse Practitioner experience on resume.MD Guidelines on resume is a huge plus.Behavioral health HUGE PLUS. 
Responsibilities: 
  • The Clinical Case Manager will be a member of our Clinical Center of Excellence.  This role will provide clinical expertise and serve as a critical link between all parties involved in disability cases.  Using Guidelines, which is the gold standard in clinical guidelines in this industry, the Clinical Case Manager will facilitate medically sound decisions, ensure absence and disability claims are administered effectively, and deliver compassionate care to our client employees. 
  • Serve as primary resource on team managing medical disability and accommodation cases.
  • Present cases to a panel that includes physicians in weekly “round table/touch point” meetings which requires dynamic communication, critical thinking, negotiation skills, holistic case conceptualization, and proactive case management planning.
  • Display a professional/corporate presence and presentation style with the ability to demonstrate excellent problem-solving skills when questioned on your case management plans. 
  • Consult on medical, behavioral health, and accommodation claims as needed, if within the scope of licensure and clinical expertise.
  • Assist employee-client in making informed choices via patient advocacy in alignment with Medical Disability Guidelines (MDG) and employer-based benefit plans and/or laws regulating disability management.
  • Act as a liaison between all parties required in case management to facilitate continuous communication and consensus.
  • Act as liaison to client’s Employee Assistance Program (EAP) to facilitate coordination of care and promote referrals to best in class behavioral health providers.
  • Provide documentation, feedback, and reports to diverse occupational populations with an underlying emphasis on returning medically able individuals to productive endeavor.
  • Manage caseload efficiently, organizes priorities, provides timely intervention and maintains sensitivity to confidential records.
  • Ensure quality standards for case management are met; implement Reed Group’s continuous quality improvement process whenever efficiencies or quality standards are not met.
  • Drive return to work process from beginning of case to closure.

You have:
  • Registered Nurse, Nurse Practitioner, or comparable license with experience, with working knowledge of disability, client processes, and case management.
  • Minimum of 5 years medical advisory experience in occupational health, worker compensation, disability, health case management, or utilization review.
  • Minimum of 2 years as a Clinical Case Manager.

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