Field Nurse Case Manager

2 weeks ago

Las Vegas, Nevada, United States EagleOne Case Management Solutions Full time
Job Overview

Position Title: Medical Case Manager

Reports To: Supervisor or Manager

Department: Operations

Summary

This role involves working in partnership with clients, injured individuals, and insurance providers to deliver comprehensive case management services aimed at ensuring suitable medical care and promoting a swift return to work.

Key Responsibilities:

  • Exhibits a thorough understanding of and applies Eagle OneTM case management protocols effectively.
  • Collaborates with management, colleagues, and account representatives to address complex cases, resolve claim obstacles, and develop resolution strategies.
  • Conducts initial and ongoing assessments of injuries, diagnoses, and medical treatments throughout the claim process, ensuring the appropriateness of medical interventions based on established disability guidelines.
  • Develops return-to-work plans and works collaboratively with injured workers, healthcare providers, therapists, and employers to facilitate timely reintegration into the workplace.
  • Delivers consistent and exceptional service to clients, ensuring their needs are met.
  • Demonstrates the ability to engage with diverse personalities while upholding the core values of the organization.
Essential Duties:

  • Manages a caseload of 22-25 active field case management files for full field cases, 45-55 telephonic case management files, or 35-45 mixed TCM/FCM cases, depending on complexity.
  • All full-time medical case managers are expected to maintain a minimum billing of 40 hours per week.
  • Maintains organization in daily and weekly activities, including prioritizing and scheduling appointments and completing task lists.
  • Participates in all mandatory meetings and training sessions.
  • Communicates timely updates and reports to clients and insurance carriers regarding the medical progress of claims.
  • Ensures the maintenance of a comprehensive medical file, organized chronologically and free of duplicate information, in a paperless format.
  • Utilizes critical thinking to provide cost-effective recommendations for care and return-to-work strategies.
  • Offers expert consultation on interpreting medical information and its implications for cases.
  • Adheres to relevant jurisdictional rules and regulations as applicable to each case.
  • Attends field visits as required by client protocols and is available for additional visits as needed within designated driving ranges.
Qualifications

To succeed in this role, candidates must be detail-oriented with outstanding communication and interpersonal skills. Registered Nurses must possess strong writing abilities for documentation and be comfortable with computer navigation. The qualifications listed below represent the knowledge, skills, and abilities required for this position. Reasonable accommodations may be made for individuals with disabilities to perform essential functions.

Education and Experience:

  • Active RN licensure in the state of employment.
  • Bachelor's Degree preferred.
  • Additional certifications such as CCM, CDMS, or CLNC are advantageous.
Reasoning Ability: Ability to identify problems, gather data, establish facts, and draw valid conclusions.

Computer Skills:

To perform this job effectively, individuals should be proficient in Microsoft Windows/Office (Word, Excel, and Outlook), capable of navigating the internet for research, and possess a general understanding of computer navigation. Typing skills of 45+ wpm are required.

Professional Skills:

  • Knowledge of workers' compensation jurisdictional rules and 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.
  • Exceptional customer service skills are necessary.
  • Previous case management experience is beneficial.
  • Clinical experience in orthopedic or occupational health settings is a plus.
  • Bilingual abilities are advantageous.
  • A valid driver's license and the ability to travel to appointments are required for field case managers.
Competencies: Successful candidates will demonstrate the following competencies: Customer Service, Oral Communication, Teamwork, Ethics, Organizational Support, Adaptability, Attendance/Punctuality, Dependability, Initiative, Judgment, Motivation, Planning/Organizing, Professionalism, Quality, and Quantity.

Work Environment: The characteristics of the work environment are representative of those an employee may encounter while performing essential functions. Reasonable accommodations may be made for individuals with disabilities.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform essential functions. Reasonable accommodations may be made for individuals with disabilities. The employee must frequently lift and/or move up to 10 to 15 pounds. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear (typing for 5-8 hours per day). The employee is frequently required to stand, walk, sit, and reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus.

Company Overview

EagleOne Case Management Solutions offers great benefits, including paid holidays and a Monday to Friday work schedule with weekends off.

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