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Field Nurse Case Manager
2 months ago
Position Title: Medical Case Management Specialist
Reports To: Supervisor or Manager
Department: Operations
Summary
As a Medical Case Management Specialist, you will collaborate closely with clients, injured individuals, and insurance providers to deliver comprehensive case management services. Your primary goal will be to ensure appropriate medical care and facilitate a prompt return to work.
Key Responsibilities:
- Apply Eagle OneTM case management protocols effectively.
- Collaborate with management, colleagues, and account representatives to resolve complex cases and claim barriers.
- Conduct initial and ongoing assessments of injuries, diagnoses, and medical treatments throughout the claim process, ensuring the appropriateness of care based on established guidelines.
- Develop return-to-work strategies and work collaboratively with injured individuals, healthcare providers, therapists, and employers to promote timely reintegration into the workplace.
- Provide exceptional service consistently to our clients.
- Demonstrate the ability to work with diverse personalities while upholding the company's core values.
- Manage a caseload of 22-25 active field case management files for full field roles, or 35-45 for mixed telephonic and field management, depending on case complexity.
- Maintain a minimum billing of 40 hours per week for full-time medical case managers.
- Stay organized in daily and weekly activities, including prioritizing appointments and managing a to-do list.
- Participate in all mandatory meetings and training sessions.
- Provide timely updates and reports to clients and insurance carriers regarding the medical progress of claims.
- Maintain comprehensive medical files in a chronological order, ensuring no duplication of information in a digital format.
- Utilize critical thinking to offer cost-effective care recommendations and return-to-work strategies.
- Provide expert consultation on medical information and its implications for cases.
- Adhere to jurisdictional regulations and apply them appropriately to each case.
- Attend field visits as required by client protocols and account instructions, within designated driving ranges.
To excel in this role, candidates must be detail-oriented with outstanding communication and interpersonal skills. A strong proficiency in writing reports and comfort with computer navigation is essential. The following qualifications are required:
Education and Experience:
- Active RN licensure in the state of employment.
- Bachelor's Degree preferred.
- Additional certifications (e.g., CCM, CDMS, CLNC) are advantageous.
Computer Skills:
Proficiency in Microsoft Windows/Office (Word, Excel, Outlook) is required, along with the ability to navigate the internet for research purposes. Typing skills of 45+ wpm are necessary.
Professional Skills:
- Knowledge of workers' compensation regulations is a plus.
- Able to thrive in a fast-paced environment.
- Strong organizational skills are essential.
- Excellent written and verbal communication skills are required.
- Prior case management experience is preferred.
- Clinical experience in orthopedic or occupational health settings is beneficial.
- Bilingual candidates are a plus.
- A valid driver's license is required for field case managers.
- Customer Service: Effectively manage challenging customer situations and respond promptly to needs.
- Communication: Clearly articulate ideas and listen effectively.
- Teamwork: Collaborate with team members and support collective goals.
- Ethics: Uphold integrity and organizational values.
- Adaptability: Adjust to changing work environments and manage competing demands.
- Dependability: Follow instructions and take responsibility for actions.
- Initiative: Seek opportunities for self-development and increased responsibilities.
- Planning/Organizing: Prioritize tasks and develop realistic action plans.
- Professionalism: Treat others with respect and maintain composure under pressure.
- Quality: Strive for accuracy and thoroughness in all tasks.
Physical Demands: Employees must frequently lift and/or move up to 10-15 lbs. Regular use of hands for typing and communication is required, along with the ability to sit for extended periods while performing job duties.
