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Nurse Case Management Specialist
2 months ago
Overview:
Are you equipped with the necessary skills, experience, and determination to excel in this position? Read on to discover more.
At CCMSI, we seek the most talented individuals to become part of our professional team.
As a premier Third Party Administrator in self-insurance solutions, we are driven by a shared mission to provide outstanding service to our clients.
As an Employee-Owned Organization, we prioritize the growth of our personnel through structured career development initiatives, recognizing and rewarding both individual and team achievements.
Certified as a Great Place To Work, our employee satisfaction and retention rates are in the 95th percentile.Reasons to consider a career with CCMSI:
Culture:
Our Core Values are deeply ingrained in our culture, reflecting how we regard our employees as valued partners—with integrity, passion, and enthusiasm.
Career Development:
CCMSI provides comprehensive internships and internal training programs aimed at promoting advancement within our organization.
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 ESOP.
Work Environment:
We are committed to creating a workplace where employees look forward to coming to work every day, equipped with the resources necessary to perform their duties, and where claims staff manage reasonable caseloads.
Medical Case Manager - Hybrid with Travel Requirements
Are you a committed nurse with a strong interest in medical case management? We are looking for an experienced Medical Case Manager to join our team and significantly impact the lives of injured workers.
This position entails comprehensive oversight of medical case files, ensuring that care is both effective and efficient, ultimately leading to optimal outcomes.
Key Responsibilities:
Manage assigned cases by evaluating medical needs, work status, and creating customized action plans.
Encourage communication among injured workers, employers, providers, adjusters, and attorneys, fostering collaborative relationships to achieve maximum medical improvement and a safe, timely return to work.
Conduct thorough reviews of medical records to confirm the necessity and appropriateness of care, collaborating closely with all parties to expedite recovery and minimize costs.
Develop and implement individualized, functionally oriented treatment plans in collaboration with adjusters, ensuring all actions comply with state regulations and company standards.
Travel to appointments as required, providing direct support and oversight for case management.Qualifications:
Nursing Degree Required:
BSN preferred with 3-5 years of clinical experience in Trauma, Rehabilitation Therapy, Orthopedics, Workers' Compensation, Occupational Medicine, or Medical Surgical.
Experience:
Previous experience in medical case management is essential.
Licensing:
Must possess a current jurisdictional nursing license.
Skills:
Strong communication, problem-solving, and interpersonal skills with proficiency in Microsoft Office.
Work Environment:
Hybrid and Flexible Schedule:
Dependent on case assignments and appointments, offering a blend of in-office and remote work.
This is an excellent opportunity to utilize your nursing expertise in a dynamic, supportive environment where you can make a meaningful difference.
We encourage you to explore this opportunity to deliver 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 for the injured worker, employer, provider, adjuster, and attorney where permitted, fostering non-adversarial relationships while progressing towards maximum medical improvement, safe early return to work, and file closure.
The case manager monitors treatment and collaborates with the adjuster in accordance with CCMSI's claims management guidelines and utilization management programs.
Review all medical records/documentation for medical necessity and appropriateness of care.Work with all parties involved in the claim management to formulate a plan for rapid, safe, and whenever possible, early return to work.
Document cost savings and accurately bill for all work performed.Participate in problem-solving to develop an effective strategy for claim closure.
Maintain the file in accordance with CCMSI's claims handling guidelines and incorporate the essential activities of case management as defined by Certification guidelines throughout the medical case management process on each file.
Develop the medical case management plan for each claim in conjunction with the adjuster. Each managed claim should contain individually focused, functionally oriented treatment plans. Maintain a close working relationship with all parties involved in the claim as allowed per state jurisdiction.Make recommendations for referrals when necessary and appropriate, for independent medical evaluation, treatment, consultation, second opinion, site evaluations, etc.
Support and foster a team-building environment for all internal and external customers, ensuring that their needs are met in a timely and efficient manner.
Perform other duties as assigned.Qualifications:
To perform this job successfully, 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 the essential functions.
Excellent verbal and written communication and interpersonal skills required.
Ability to manage multiple and changing priorities with skill and dignity.
Attention to detail, planning, and documentation.
Discretion and confidentiality are a must.
Knowledge of case management philosophy, process, outcomes, and goals.
Reliable, predictable attendance within client service hours for the performance of this position.
Responsive to internal and external client needs.
Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and/or Experience
RN preferred BSN 3-5 years of clinical experience related to Trauma, Rehabilitation Therapy, Orthopedics, Workers' Compensation Occupational Medicine Medical Surgical.
Proficient with Microsoft Office programs.
Certificates, Licenses, Registrations
New Mexico Nursing license 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; searching for the best ideas; viewing change as an opportunity; insisting upon 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, ESOP, and 401K.
