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Registered Nurse(RN) – Workers Compensation Case Manager ~ Columbusm, OH
About the Job
About this company:
ExamWorks Clinical Solutions is a national provider of case management, pharmaceutical and Medicare compliance solutions providing coverage at the local, regional and national levels. Our wide spectrum of customers includes Carriers, Employers, Excess Carriers, and Third Party Administrators.
ExamWorks Clinical Solutions provides direct medical management services and works closely with the injured employee, physician representatives and the claim team to facilitate the most effective case management solution. Case management services promote employee health and an overall reduction of illness, injury, and lost time from work while reducing medical and indemnity claim costs.
ExamWorks Clinical Solutions services are provided through ASN, which a URAC Accredited Case Management provider. Credentialed professionals provide consultative assistance on an array of cases related to return-to-work transitions, disease management and complex case resolution.
Title: Registered Nurse(RN) – Workers Compensation Case Manager
The RN case manager is responsible for the timely coordination and management oversight of quality healthcare services necessary to meet an individual’s specific health care needs in a cost effective manner. This position acts as a liaison with patient/family, employer, provider (s), insurance companies and healthcare personnel. The RN case manager is responsible for timely service delivery and reporting, compliance with URAC Standards, quality of work product and to represent ExamWorks Clinical Solutions in a professional and customer oriented manner. A registered nurse in this position assesses, manages, plans, implements, coordinates and evaluates all case management activities associated with an injured employee to communicate the medical and disability needs and treatment of the injured worker to the claims professional and to facilitate timely return to work.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Assess and analyzes injured worker’s medical and/or vocational status and develops a viable, realistic action plan.
- Meet with individuals in their homes, work-sites, physician’s or therapist’s office to provide ongoing case management services.
- Develop an action plan from date of referral to closure.
- Implement, calculate and document cost savings.
- Manage progress towards desired outcomes.
- Frequent communication with the injured worker, medical providers, attorneys, employers, and claims professionals and ECS management.
- Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care.
- Apply all special service instructions required by customers/accounts.
- Appropriately applies all laws and regulations to the provision of rehabilitation services.
- Testifies when called upon to do so, to substantiate any casework or reports that may be seen as relevant to hearing involving client.
- Evaluates outcomes and case goals.
- Prepares reports and other required documentation for casework activities.
- Arranges referrals, consultations, therapeutic services, and confers with other specialists regarding course of care and treatment.
- Upholds applicable state and federal regulatory requirements that govern workers’ compensation disability.
- Substantiates case activities carried out/services rendered in all activity reports completed.
- Minimum 2 years clinical nursing background
- Prior case management and workers’ compensation experience a plus
- Professional certification in a clinical specialty
- At least 5 years experience as a case manager preferred
- Ability to multitask in a fast paced work environment
- Strong computer skills with experience in Microsoft Office Products, including Word, Outlook, and Excel
- Excellent communication skills (written and verbal) with ability to work automated files
- The level of education desired for candidates in this position is a Bachelor’s degree
- A bachelor’s degree in a health related field and licensure as a health professional (RN) (current and active)
- BSN preferred
- Diploma or Associates Degree in Nursing acceptable
LICENSES AND CERTIFICATIONS
- Nursing/Registered Nurse (RN)
- Licensed RN in accordance with state laws of jurisdiction.
- State certifications in accordance with state laws of jurisdiction
- Obtaining and maintaining one of the following certifications, CCM, CIRS, CDMS, CRRN or CRC designations is required within four years of hire; these designations are required where dictated by state regulations
- Ability to read, analyze and interpret common and complex correspondence, various reporting records, and legal contracts and documents.
- Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
- Ability to respond appropriately and professionally to all inquiries or complaints from customers, regulatory agencies, upper management, and/or members of the business community.
- Ability to effectively present information one-on-one, in small to large groups, to top management, and/or clients or vendors of the company.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position generally consists of:
- Sitting 5 to 8 hours a day.
- Light to moderate walking and standing required within the home office or while in the field or during travel.
- Daily travel in the field, some telecommuting.
This job has no supervisory responsibilities.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Extended hours are occasionally required beyond the regular eight (8) hour work day.
- The noise level in the work environment is usually moderate, but noise level may increase during outside office functions.
- Works in a home office environment and/or occasionally from an office environment.
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