RN Case Manager - Complex Workers' Comp - Los Angeles (Must live in L.A.) - Hybrid

Responsibilities

• Processes the case utilizing client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Affirms the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with client’s model through interdisciplinary collaboration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Maintains services being provided for continued appropriateness and reports to client and carrier
• Evaluates the client’s progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/dis-ease process, treatment options, and present care
• Promotes the client’s/family’s self-advocacy skills to achieve maximum self-sufficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
• Frequently requires travel to patient appointments

Requirements

• Registered nurse
• BSN preferred
• CCM or equivalent certification
• Three years or more of related experience and/or training or equivalent combination of education and experience

Qualifications

• Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
• Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form
• Knowledge of database software, internet software, and Microsoft word processing software
• Knowledge of contract-level acceptance by Paradigm of the Case Manager to manage their cases

Skills

• Knowledge of contract-level acceptance by Paradigm of the Case Manager to manage their cases

Benefits

N/A

Pay

N/A

Schedule

N/A