Medical Case Manager I
- Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others.
- Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans.
- Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness.
- Provides assessment, planning, implementation and evaluation of patient’s progress.
- Attends doctors, other providers, home and in some cases, attorney’s visits.
- Attends hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy. Initial home visit for initial evaluation.
- Implements care such as negotiation the delivery of durable medical equipment and nursing services.
- This role requires regular travel, dependent on the injured worker’s injuries and needs. The employee must be available for local travel up to approximately 60% of the work week/month
- This role may require overnight travel.
- Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment.
- Experience as a RN, Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred.
- Ability to meet with the patient, their physicians, other healthcare providers, attorneys, and advisors/clients and coworkers.
- A cost containment background, such as utilization review or managed care is helpful.
- Strong interpersonal, time management and organizational skills.
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
- Ability to work both independently and within a team environment.
- Graduate of accredited school of nursing.
- Current RN Licensure in state of operation.
- Must have national certification – CCM, CRC, COHN, CRRN, CDMS
- A valid driver’s license, reliable transportation, and ability to travel to assigned locations is required.
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