Field Nurse Case Manager

2 weeks ago

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

Position Title: Medical Case Management Specialist

Reports To: Supervisor or Manager

Department: Operations

Summary

Collaborates with clients, injured workers, and insurance providers to deliver comprehensive case management services, ensuring suitable medical care and facilitating a prompt return to work.

Key Responsibilities:

  • Demonstrates proficiency in applying Eagle OneTM case management protocols.
  • Engages with management, colleagues, and account representatives to address complex cases, resolve claim barriers, and plan resolutions.
  • Conducts initial and ongoing assessments of injuries, diagnoses, and medical treatments throughout the claim lifecycle, documenting the appropriateness of medical interventions based on disability guidelines.
  • Develops return-to-work strategies and collaborates with injured workers, healthcare providers, therapists, and employers to ensure timely reintegration into the workplace.
  • Delivers consistent and exceptional service to clients.
  • Exhibits adaptability in working with diverse personalities while upholding the company’s core values.
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 based on complexity.
  • Maintains a minimum billing requirement of 40 hours per week for full-time medical case managers.
  • Organizes daily and weekly tasks, prioritizing appointments and managing a to-do list effectively.
  • Participates in all mandatory meetings and training sessions.
  • Communicates regularly with clients and insurance carriers regarding the medical progress of claims.
  • Maintains comprehensive medical files in a chronological order without duplication in a paperless format.
  • Utilizes critical thinking to provide cost-effective care recommendations and return-to-work strategies.
  • Offers expert consultation on interpreting medical information and its implications for cases.
  • Adheres to jurisdictional regulations and applies them appropriately to each case.
  • Conducts field visits as required by client protocols and is available for additional visits as needed.
Qualifications

To excel in this role, candidates must be detail-oriented with outstanding communication and interpersonal skills. Registered Nurses should possess strong writing abilities for report generation and be comfortable with computer navigation. The following qualifications are essential:

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:

Proficiency in Microsoft Windows/Office (Word, Excel, Outlook), internet navigation for research, and general computer skills. Typing speed of 45+ wpm is required.

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.
  • Exceptional customer service skills are necessary.
  • Previous case management experience is beneficial.
  • Clinical experience in orthopedic or occupational health settings is a plus.
  • Bilingual candidates are preferred.
  • A valid driver's license is required for field case managers.
Competencies: Successful candidates will demonstrate the following competencies:
  • Customer Service - Manages challenging customer situations; responds promptly to needs; seeks feedback to enhance service.
  • Oral Communication - Communicates clearly and persuasively; listens attentively; engages in group presentations.
  • Teamwork - Balances team and individual responsibilities; welcomes feedback; contributes to a positive team environment.
  • Ethics - Treats individuals with respect; maintains integrity and ethical standards.
  • Organizational Support - Adheres to policies and procedures; completes tasks timely.
  • Adaptability - Adjusts to changes in the work environment; manages competing demands.
  • Attendance/Punctuality - Consistently present and punctual.
  • Dependability - Follows instructions; takes responsibility for actions.
  • Initiative - Seeks additional responsibilities; volunteers for tasks.
  • Judgment - Makes sound decisions; includes appropriate individuals in decision-making.
  • Motivation - Sets and achieves challenging goals; demonstrates persistence.
  • Planning/Organizing - Prioritizes tasks effectively; develops realistic action plans.
  • Professionalism - Treats others with respect; follows through on commitments.
  • Quality - Strives for accuracy and thoroughness; seeks ways to improve performance.
  • Quantity - Meets productivity standards; completes work in a timely manner.
Work Environment: The work environment is typically moderate in noise level, and reasonable accommodations may be made for individuals with disabilities.

Physical Demands: Employees may need to lift and/or move 10 to 15 lbs frequently. Regular tasks include using hands for typing and communication, standing, walking, and sitting for extended periods. Specific vision abilities required include close 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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