Clinical Nurse Utilization Manager: Case Management Specialist
1 month ago
As a Clinical Services Manager - RN Telephonic Case Management, you will play a pivotal role in ensuring optimal recovery outcomes for every claimant while fostering trust, providing education, and delivering personalized care. You will collaborate with field case managers to provide case direction when on-site intervention is required.
Key Responsibilities- Adhere to professional practice guidelines set forth by the state Board of Nursing and Division of Workers' Compensation.
- Collaborate with clients and business partners to maintain quality standards across all accounts.
- Demonstrate expertise in case management standards of practice and apply them effectively.
- Utilize advanced knowledge of injury types, medications, comorbidities, treatment options, and job duties to advise on treatment plans.
- Conduct thorough interviews with injured individuals to assess overall recovery, including occupational and non-occupational injuries.
- Collaborate with treating physicians/providers to create and implement tailored treatment plans.
- Work with employers and physicians to modify job duties where feasible to facilitate early return to work.
- Evaluate and adjust case goals based on injured/disabled individuals' progress and treatment effectiveness.
- Independently manage workload, prioritizing cases and deciding the most effective approach.
- Associate's or Bachelor's degree in nursing or a related field, with an active Registered Nurse (RN) license in good standing.
- 2+ years of clinical practice experience, preferably in workers' compensation-related fields.
- Professional certification in Case Management (CCM, CRC, CRRN, COHN), Disability Management (CDMS), or Qualified Rehabilitation Provider (QRP) is preferred.
- Ability to effectively advocate recommendations with physicians/providers, employers, and customers.
- Strong organizational and planning skills.
- Bilingual in English and Spanish.
- Current CA RN license, CA practice experience, or CA domicile, or recent CA domicile.
- The work environment is a standard office setting with moderate noise levels.
- While performing duties, the employee must remain stationary for over 50% of the workday, move around the office, use hands to operate a computer and other office equipment, and communicate with coworkers.
- Specific vision abilities required include close vision and the ability to adjust focus.
- The employee may occasionally lift and/or move up to 10 pounds.
- Possibility for remote and hybrid work opportunities.
- Great work-life balance.
- Medical, Dental, and Vision insurance.
- Company-paid Life and Disability Insurance.
- Flexible Spending Accounts.
- 401(k) with employer contribution.
- Generous Paid Time-Off policies.
- Employee Assistance Program.
- Referral Program.
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