Telephonic Nurse Case Manager
REMOTE
Job Type
Full-time
Description
A Telephonic Nurse Case Manager is responsible for providing telephonic medical case management for Worker’s Compensation and Liability Injury Management programs. Case Management is a collaborative process to promote quality cost effective outcomes, which enhance the physical, psycho-social, and vocational health of individuals. This includes assessing, planning, implementing, coordinating, and evaluation of service options. The goal of the Case Manager is to assist the injured worker in receiving appropriate, cost effective medical care for their injury in a timely manner, and to expedite their return to work.
Position Logistics: Non-Exempt, Full-time, eight (8) hour work day, Monday – Friday, Travel may be required.
Please note: This position requires a compact RN license and NY state RN license in good standing (or ability to acquire NY state RN license)
Responsibilities may include, but are not limited to:
- Once a file is identified as needing a Telephonic Case Manager, the TCM ensures telephonic case management activities are processed in accordance with EK’s standard. Activities may include:
o Completing referrals within computer database from either injury report or information gathered from the web-based system
o Performs 3-point contact on new files and, depending on account, forwards within 24 or 72 hours from date of referral
o Reviewing and evaluating all medical correspondence and provider reports obtained to determine work status of IWs or patients
o Reviewing treatment plan history and direction of file with client, when necessary
o Providing a 24-hour update after all significant activity
o Evaluating clinical status of claimant and researches for alternative options to treatment as warranted
o Communicating with the claim’s examiners regarding directives, and provides updates on file status
o Arranging transportation services when necessary and authorized
o Evaluating therapy facilities and their progress on specific cases
o Preparing comprehensive notes following any discussions had with IW, medical providers, claims examiners, and employers in the case file in EK TCM Ahshay and client system, per policy standards and procedure
o Completes initial reports every 14 days and every 30 days thereafter, according to account profile and service type.
o Ability to handle a variable case load dependent on service and client type
- Utilizes the nursing process in conjunction with URAC standards, EK Standards and client guidelines to manage and move files forward.
o Assessment:
§ Perform a complete nursing evaluation
§ Collect relevant data to the patient’s physical and mental status, functional capability, personal and environmental factors
§ Analyze the collected data to determine problems, strengths and needs of the patient
o Planning:
§ Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation
§ Upon authorization, implement this plan of care with patient, physician and health care providers
o Implementation:
§ Make regular personal contact to oversee the contracted services in order to maintain quality of care
§ Arrange for care/services as needed (home care, procedures, medication, equipment or supplies)
§ Monitor the plan of care with modifications or changes suggested to the patient and physician as the need arises
§ Coordinate information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any is involved)
o Evaluation:
§ Determine the progress and the effectiveness of the care
§ Prepare a monthly report of the patient’s progress and specific cost savings
§ Evaluating clinical files ongoing and ensuring care is medically necessary
- Accurately and efficiently identifying properly requested files for Triage and processes for determination of telephonic or field case management.
- Evaluating clinical files ongoing and ensuring care is medically necessary
- Identifying cases that are not utilizing the MPN or PPO network providers, and appropriately redirects IW to the network providers
- Ensuring productivity and timeliness of reviews follow EK and client departmental policies, standards and procedures
- High level of comfort with computer based activities including typing, managing all activities within a web based platform and leveraging technology to attend visits or assessments virtually, when appropriate, by means such as Zoom, Facetime and telemedicine platforms.
- Identifying and recommending referrals to Field-Based Case Management and EK Specialty Programs.
- Handling all medical information and reports as confidential information, ensuring accuracy of files and notepad entries
- Attending in-service meetings and continuing education seminars, as appropriate
- Utilizing effective oral communication, written communication and organization skills and demonstrates the ability to prioritize case activities
- Professional interaction with EKHS staff, members of the medical community, and all customers of EKHS; both in oral and written forms
- All work is done within the scope of practice for a Registered Nurse in in the state where case management services
- May act as preceptor for new or covering Telephonic Case Managers as requested by management
- Participate in EKHS Nursing teleconferences and staff meetings as scheduled.
- Adherence to EKHS Employee Handbook
- Other duties as assigned
Requirements
Qualifications:
- Graduate of an accredited school of nursing
- Valid state-appropriate RN license in good standing with no restrictions
- Compact RN License
- May be required to obtain additional state RN licenses (NY)
- Possesses and can demonstrate the professional and technical skills needed
- Experience in Field or Telephonic Case Management, Workers’ Compensation or Liability experience highly preferred, but not required
- Experience in Home Health Care, Occupational Health considered a plus
- Certified Case Manager (CCM), Certified Occupational Health Nurse (COHN or COHN-S) or Certified Rehabilitation Registered Nurse (CRRN) highly preferred, but not required.
- High comfort level with computers and computer programs (MS Word, MS Excel, Email)
- Excellent Written and Oral Communication Skills
- Excellent Interpersonal Skills
- Strong Organization Skills
- High comfort level with computers and computer programs (MS Word, MS Excel, Email)
- Ability to work independently with minimal supervision
- Ability to meet deadlines in a high pressure, time sensitive environment
- Ability to lift up to 20 lbs
Physical Requirements: Candidate must be able to sit the majority of an 8-hour day except for lunch and break times. Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPAA compliant.
*Requires DSL, fiber, or cable internet connection from home 10 mbps preferred or better *