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Nurse Case Management Specialist
2 months ago
Position Overview:
Are you a skilled nursing professional with a commitment to excellence in medical case management? At CCMSI, we are dedicated to attracting top-tier talent to enhance our team of experts.
As a premier Third Party Administrator in self-insurance services, we share a unified goal of providing outstanding service to our clients.
As an Employee-Owned Company, we prioritize the growth of our staff through comprehensive career development initiatives, recognizing and rewarding both individual and team achievements.
Proudly certified as a Great Place To Work, our employee satisfaction and retention rates are among the highest in the industry.Why Consider a Career with CCMSI:
Company Culture:
Our Core Values are deeply integrated into our workplace culture, emphasizing respect, integrity, and enthusiasm for our employees.
Professional Development:
CCMSI provides extensive internship opportunities and internal training programs to facilitate career advancement within our organization.
Comprehensive Benefits:
Our benefits package includes 4 weeks of paid time off in your first year, in addition to 10 paid holidays. We also offer Medical, Dental, Vision, Life Insurance, Critical Illness coverage, Short and Long Term Disability, 401K, and an Employee Stock Ownership Plan (ESOP).
Work Environment:
We are committed to creating a workplace where employees look forward to coming in each day, equipped with the necessary resources to excel in their roles, and manageable caseloads for our claims staff.
Medical Case Manager - Hybrid Role with Travel Responsibilities
We are in search of a dedicated nurse who is passionate about medical case management to join our team and significantly impact the lives of injured workers.
This position entails the thorough management of medical case files, ensuring that care is both effective and efficient, leading to optimal patient outcomes.
Key Responsibilities:Oversee assigned cases by evaluating medical needs, work status, and creating customized action plans.
Encourage communication among injured workers, employers, healthcare providers, adjusters, and legal representatives, fostering collaborative relationships to achieve maximum medical improvement and a safe, timely return to work.
Conduct detailed reviews of medical records to verify the necessity and appropriateness of care, collaborating closely with all parties to expedite recovery and minimize costs.
Design and implement individualized, functionally oriented treatment plans in collaboration with adjusters, ensuring compliance with state regulations and company standards.
Travel to appointments as required, providing direct support and oversight for case management.Qualifications:
Nursing Degree Required:
A BSN is preferred, along with 3-5 years of clinical experience in Trauma, Rehabilitation Therapy, Orthopedics, Workers' Compensation, Occupational Medicine, or Medical Surgical.
Experience:
Prior experience in medical case management is essential.
Licensing:
A current nursing license in the relevant jurisdiction is required.
Skills:
Excellent communication, problem-solving, and interpersonal skills, along with proficiency in Microsoft Office.
Work Environment:
Hybrid and Flexible Schedule:
Depending on case assignments and appointments, this role offers a combination of in-office and remote work.
This is a remarkable opportunity to utilize your nursing expertise in a dynamic, supportive environment where you can make a meaningful difference.
We look forward to your contributions in delivering the highest quality care to those in need.
Responsibilities:
Review all assigned files to evaluate the claimant's medical needs, work status, and current condition to develop and document an action plan for each referred claim.
Act as a facilitator among injured workers, employers, healthcare providers, adjusters, and attorneys, fostering collaborative relationships while striving for maximum medical improvement, safe early return to work, and claim resolution.
The case manager monitors treatment and collaborates with the adjuster in accordance with CCMSI's claims management guidelines and utilization management protocols.
Review all medical records/documentation for medical necessity and appropriateness of care.Collaborate with all parties involved in the claim management process to formulate a plan for rapid, safe, and, whenever possible, early return to work.
Document cost savings and accurately bill for all work performed.Engage in problem-solving to develop effective strategies for claim resolution.
Maintain case files in accordance with CCMSI's claims handling guidelines, incorporating essential case management activities as defined by certification standards throughout the medical case management process.
Develop the medical case management plan for each claim in conjunction with the adjuster, ensuring each managed claim contains individually focused, functionally oriented treatment plans. Maintain a close working relationship with all parties involved in the claim as permitted by state jurisdiction.
Make recommendations for referrals when necessary and appropriate, for independent medical evaluations, treatment consultations, second opinions, site evaluations, etc.
Support and promote a team-building environment for all internal and external customers, ensuring their needs are met promptly and efficiently.
Perform other duties as assigned.Qualifications:
To excel in this role, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Exceptional verbal and written communication and interpersonal skills are required.
Ability to manage multiple and shifting priorities with professionalism and composure.
Attention to detail, planning, and documentation are critical.
Discretion and confidentiality are paramount.
Knowledge of case management philosophy, processes, outcomes, and goals is essential.
Reliable, predictable attendance during client service hours is necessary for this position.
Responsive to the needs of internal and external clients.
Ability to communicate clearly, both verbally and in writing, with all stakeholders.
Education and/or Experience
RN preferred with a BSN and 3-5 years of clinical experience related to Trauma, Rehabilitation Therapy, Orthopedics, Workers' Compensation, Occupational Medicine, or Medical Surgical.
Proficient in Microsoft Office applications.
Certificates, Licenses, Registrations
New Mexico Nursing license is required.
CORE VALUES & PRINCIPLES
Responsible for upholding the CCMSI Core Values & Principles, which include: performing with integrity; passionately focusing on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; seeking the best ideas; viewing change as an opportunity; insisting on excellence; creating an atmosphere of excitement, informality, and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; fostering constructive relationships; taking the initiative to improve processes; and leading by example.
CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefits package, including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life Insurance, ESOP, and 401K.
