Telephonic Case Manager

About the role

We're now hiring an RN Telephonic Case Manager to join our remote team. Ideal candidates must have a multi-state Nursing License, preferably with a National Certification (CCM, CRC, COHN, CRRC), and experience in Workers' Compensation Case Management.

Responsibilities

• Reviews case records and reports, collects and analyzes data, evaluates medical status, and identifies needs and obstacles to medical case resolution.
• Provides proactive case management services, renders opinions on case costs, treatment plans, and outcomes, and makes recommendations to facilitate case management goals.
• Maintains contact with patients/employees, physicians, and employers to facilitate return to work (RTW).
• Coordinates with claims adjusters to apprise them of case activity and secure authorization for services.
• Maintains contact with all parties involved on the case, necessary for case management.
• Makes referrals for peer reviews and IMEs by obtaining and delivering medical records and diagnostic films, notifying the patient, and conferring with physicians.
• Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessments accordingly.
• Maintains monthly production and quality assessment requirements to ensure a quality product.
• Evaluates files monthly with the supervisor to obtain directions.

Qualifications

• Associate's degree or relevant coursework/certification in Nursing is required; BSN is preferred.
• Minimum of 1-3 years diverse clinical experience.
• Minimum of 1 National Certification (CCM, CDMS, CRRN, COHN) is preferred, or must plan to attain within 36 months.
• Must be compliant with state requirements regarding national certifications.
• Excellent oral and written communications skills.
• Excellent analytical and customer service skills.
• Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes.
• Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys, and all levels of employees.
• Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes.
• Demonstrated leadership ability with a basic understanding of supervisory and management principles.
• Active RN home state licensure in good standing without restrictions with the State Board of Nursing.