Medical Case Manager I
- Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source
- Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans
- Provides assessment, planning, implementation, and evaluation of patient’s progress
- Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness
- Attends doctors, other providers, home and in some cases, attorney’s visits
- Attends hospital and/or long-term facility discharge planning conferences, etc. for the purpose of determining appropriateness of care and developing an effective long-term care strategy
- Conducts home visit for initial evaluation
- Implements care such as negotiating 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
- Additional duties as required
- Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment
- Ability to meet with the patient, their physicians, other healthcare providers, attorneys, 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 Microsoft Office, including Excel spreadsheets
- Ability to work both independently and within a team environment
- Experience as an RN Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred
- Graduate of accredited school of nursing
- Current RN Licensure in state of operation
- Certification as a CCM, CIRS, or other Case Management certifications preferred
- A valid driver’s license, reliable transportation, and ability to travel to assigned locations is required
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