RN Healthcare Advocate Specialist

2 days ago


Royal Oak, Michigan, United States Horizon Case Management Corp Full time
Nurse Case Management Professional Job Opening

Hiring immediately for a skilled Nurse Case Management Professional to join our team at Horizon Case Management Corp.

Estimated Salary: $70,000 - $90,000 per year.

About Our Company

Horizon Case Management Corp is a dynamic organization dedicated to delivering high-quality care and support services to our clients.

Job Responsibilities

The successful candidate will be responsible for managing treatment of claimants alongside workers' compensation and auto insurance adjusters, demonstrating accountability for standards of practice policies and procedures, quality assurance and the goals of the organization.

Main Tasks:

  • Reviews patient clinical status and history to determine the causal nature of patient's symptoms as related to reported work injuries.
  • Evaluates the medical necessity/reasonableness of proposed and ongoing treatment.
  • Develops and implements case management plans, collaborating with healthcare providers and claims handlers as needed.
  • Fosters effective communication among stakeholders to ensure seamless care coordination.
  • Monitors and analyzes the effectiveness of case management interventions on quality outcomes, fiscal parameters and customer satisfaction.

Qualifications

To succeed in this role, applicants should possess:

  • A valid Registered Nurse (RN) license and active unrestricted registration.
  • A Bachelor's degree in Nursing (BSN) or higher.
  • Certified Case Management (CCM) certification or obtain within 2 years of working with the company.
  • At least three years of active patient or clinical care experience.
  • Strong communication, problem-solving and critical thinking skills.
  • Experience working with auto injury and workers' compensation clients or insurance preferred.


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