Telephonic Nurse Case Manager
Found in: Resume Library US A2 - 2 weeks ago
AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.
PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.
Responsibilities:
Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary
Responsible for accurate comprehensive documentation of case management activities in case management system.
Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.
Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.
Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
May assist in training/orientation of new staff as requested
Other duties may be assigned.
Supports the organization's quality program(s).
Qualifications:
Education & Licensing
Active unrestricted Nevada RN license.
Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
Ability to acquire, and maintain, appropriate Professional Certifications and Licenses to comply with respective state laws may be required
Preferred for license(s) to be obtained within three - six months of starting the job.
Written and verbal fluency in Spanish and English preferred
Experience
Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required.
Skills & Knowledge:
Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
Knowledge of behavioral health
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytic and interpretive skills
Strong organizational skills
Excellent interpersonal and negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
What We Offer:
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
-
Case Manager
2 weeks ago
Las Vegas, United States Law Firm Full timeJob DescriptionJob DescriptionOur Nationwide Personal Injury firm has an opening for an experienced Case Manager working in Pre-Litigation. This is a hybrid position - part of the week in the office and the remainder days working remotely from your own home. Being Bilingual is a plus, but is not mandatory.Qualified candidates will have at least 3 years of...
-
Nurse Director Case Management
2 days ago
North Las Vegas, United States Clinical Management Consultants Full timeAn innovative organization in the Southern Nevada Metro area is actively seeking a Nurse Director Case Management. This trusted not-for-profit, sophisticated healthcare system is honored and eager to add another member to its remarkable nursing team! Director, Management, Nurse, Healthcare, Staffing, RN
-
Case Management Director II
Found in: Appcast Linkedin GBL C2 - 3 weeks ago
Las Vegas, United States Encompass Health Full timeAs a member of Senior Leadership, the Director of Case Management (DCM) is responsible for the day to day operations and human resource management of the department of Case Management. With a central focus on census management, patient care outcomes, and key care indicators, the DCM oversees the interdisciplinary plan of care and the discharge planning...
-
Case Management Director II
2 days ago
Las Vegas, United States Encompass Health Full timeAs a member of Senior Leadership, the Director of Case Management (DCM) is responsible for the day to day operations and human resource management of the department of Case Management. With a central focus on census management, patient care outcomes, and key care indicators, the DCM oversees the interdisciplinary plan of care and the discharge planning...
-
Director - Care (Case Management)
2 weeks ago
Las Vegas, United States Global Force USA Full time $101,316 - $162,095Sign on bonus may applyOn site positionPosition Summary:Oversees the overall operations of care management functions through oversight of both daily and long-term activities at the hospital. Is responsible for developing systems and processes for case management and social services, and managing department activities related to clinical quality improvement....
-
Case Manager
3 weeks ago
Las Vegas, United States Apple Grove Treatment Center Full timeJob DescriptionJob DescriptionBenefits:401(k) matchingOpportunity for advancementPaid time offJob descriptionCompassionate, professional individuals needed to support our work!Apple Grove is a multi-service agency that provides foster care services, supports to individuals with intellectual disabilities, and a variety of social programs to youth, adults and...
-
Secondary Case Manager
2 weeks ago
Las Vegas, United States WC Health Full timeJob DescriptionJob DescriptionJob DescriptionJob DescriptionWell Care Services is a Behavioral Health Clinic looking for Case Managers to join our team. We are hiring a team of case managers that will be working hands on with patients out on the field.Requirements:The role of a secondary case manager is to assist primary case management with patient...
-
Secondary Case Manager
Found in: Talent US C2 - 2 weeks ago
Las Vegas, United States WC Health Full timeJob DescriptionJob DescriptionWell Care Services is a Behavioral Health Clinic looking for Case Managers to join our team. We are hiring a team of case managers that will be working hands on with patients out on the field.Requirements:The role of a secondary case manager is to assist primary case management with patient monitoring and management of their...
-
Lead Case Manager
2 weeks ago
Las Vegas, United States Apple Grove Treatment Center Full timeJob DescriptionJob DescriptionCompassionate, professional individuals needed to support our work!Apple Grove is a multi-service agency that provides foster care services, supports to individuals with intellectual disabilities, and a variety of social programs to youth, adults and families in our community.Our mission is to provide individuals with the...
-
Lead Case Manager
3 weeks ago
Las Vegas, United States Apple Grove Treatment Center Full timeJob DescriptionJob DescriptionBenefits:401(k)401(k) matchingHealth insurancePaid time offCompassionate, professional individuals needed to support our work!Apple Grove is a multi-service agency that provides foster care services, supports to individuals with intellectual disabilities, and a variety of social programs to youth, adults and families in our...
-
Bilingual Legal Case Manager
Found in: Talent US C2 - 2 weeks ago
Las Vegas, United States Jerez Law, PLLC Full timeOur law firm is seeking an organized, self-starter to join our team as a legal case manager and work alongside attorneys to achieve our client’s goals. We need someone who is an effective communicator, incredibly organized, and self-motivated. Our ideal applicant will have experience in case management and is skilled at drafting documents and conducting...
-
Bilingual Legal Case Manager
2 weeks ago
Las Vegas, United States Jerez Law, PLLC Full timeJob DescriptionJob DescriptionOur law firm is seeking an organized, self-starter to join our team as a legal case manager and work alongside attorneys to achieve our client’s goals. We need someone who is an effective communicator, incredibly organized, and self-motivated. Our ideal applicant will have experience in case management and is skilled at...
-
Safety Case Manager
2 days ago
Las Vegas, United States Eagle Quest Full timeJob DescriptionJob DescriptionSalary: $15.00 - $32.00 per hourJoin Eagle Quest as a Safety Case Manager! Position: Part-time Safety Case Manager Eagle Quest is seeking passionate and dedicated Safety Case Managers to join our growing team! This role offers a unique opportunity to work directly with children and families in our community, providing valuable...
-
Personal Injury Case Manager
3 weeks ago
Las Vegas, United States Law Tyme, Inc. Full timeJob DescriptionJob DescriptionBenefits:401(k)Competitive salaryDental insuranceHealth insurancePaid time offVision insurance Plaintiff Pre-Litigation Personal Injury Case Manager - HybridProminent, professional, and well-known, Personal Injury firm has an opening, due to expansion, for a Case Manager.Qualified candidates will have at least 2 years of...
-
PRN, RN Case Manager Home Health
3 weeks ago
Las Vegas, United States Professional Healthcare Staffing Full timeJoin Our Cause!At Professional Healthcare Staffing (PHS), we are committed to improving the lives of our clients and our team members. We are looking to add to our team of compassionate caregivers. RN Case ManagerWe are actively searching for a committed Registered Nurse to fill a PRN position in our Home Health team. The role involves a range of duties...
-
Pre-Litigation Case Manager
2 weeks ago
Las Vegas, United States Richard Harris Law Firm Full timeJob DescriptionJob DescriptionPre-Litigation Case Manager, Las Vegas, NVRichard Harris Law Firm is seeking an experienced pre-litigation case manager. Must be able to handle a large caseload, have excellent clerical skills, be a team player, and be able to multitask. Must be a self-starter and able to work independently. Candidate must also be outgoing,...
-
Home Health RN Clinical Supervisor or Manager
Found in: Resume Library US A2 - 2 weeks ago
Las Vegas, Nevada, United States AdvisaCare Full timeAdvisaCare Strives to be YOUR first choice of employment! AdvisaCare is seeking a Home Health Clinical Supervisor to join our team in our Vegas location. Must hold an active NV state Registered Nurse License. The right candidate should be self-motivated, driven, out-going and efficient with their charting and review of documents. Monday-Friday 8:00a-5:00p...
-
Case Manager
3 weeks ago
North Las Vegas, United States Sierra Sage Full timeJob DescriptionJob DescriptionSalary: DOEBehavioral health facility seeking to fill a full-time case management position. Requirements include:High school diploma or equivalent (Bachelor’s degree preferred)Valid Nevada driver’s license1 year case management experience in a similar settingMust have excellent communication skillsMust have experience with...
-
Case Manager II
2 weeks ago
Las Vegas, United States Encompass Health Full timeJob DescriptionJob DescriptionMore personalized patient careMore professional impactBE THE CONNECTION. In your role as case manager, you can be the connection between exceptional care and the positive effect it has on every patient during their stay with us. Make an impact in a more profound way with your clinical and management skills as a part of national...
-
Home Health Registered Nurse
Found in: Resume Library US A2 - 2 weeks ago
Las Vegas, Nevada, United States AdvisaCare Full timeAdvisaCare Strives to be YOUR first choice for Employment!! Come be a part of our Growing Family! You won't be disappointed!! AdvisaCare is seeking Home Health and Hospice Registered Nurses to join our team in Las Vegas, NV and surrounding area. Must hold an active Nevada state Registered Nurse License. We have openings for: Part Time, Full Time, Per...
