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Telephonic Case Manager
3 months ago
Workers Comp RN Certified Network Case Manager
MUST RESIDE IN THE SAN ANTONIO, TX AREA
BI-LINGUAL ENGLISH/SPANISH
RN preferred - REQUIRES Certification in Case Management, i.e., CCM, CRN, CDMS, CRC, COHN, etc. within the first 12 months of employment.
Full time - hybrid schedule after completion of 3-4 weeks training - 2 days in office/3 days remote
The Telephonic Case Manager is responsible for managing workers' compensation case management files following IMO protocols and in compliance with clients' directives. Demonstrates expertise in a variety of the field's concepts, practices, and procedures. Relies on extensive experience and judgment to plan and accomplish goals. A wide variety of creativity and latitude is expected. The successful nurse candidate will be familiar with Texas Workers' Compensation as well as ODG (Official Disability Guidelines) and will collaborate with physicians and the multidisciplinary team including adjusters, medical care providers, and employers to facilitate the plan of care and assist in identification and concurrent resolution of variances.
The case manager acts as a liaison for the injured employee and communicates with the client while maintaining neutral position between all interested parties. They provide assistance to injured employees as needed with selection of treating physician from the Network provider list as well as assist claimants and physicians with specialist referrals and ensure utilization of providers within the Network. It is important to maintain communication with employer, adjuster as needed for coordination of RTW (Return to Work) efforts and initiate required forms and letters of communication as indicated throughout the case management process.
They utilize clinical/nursing skills to coordinate the individual's treatment program while maximizing cost containment and provide complete documentation in the IMO SmartCat Software, updating notes on the initial medical assessment/interview, medical status and RTW Status. Communication with claims examiners is critical, and it will be necessary to participate with file reviews to ensure that disputes or other non-medical issues are addressed accordingly.
Bachelor's Degree in nursing or a related field preferred
Bilingual in English/Spanish Required
Case Management Certification required within first 12 months of employment
Salary range $74k-$78k
