Medical Nurse Case Manager (RN)

We are currently seeking a Field Nurse Case Manager (RN) for the Wyandotte, Michigan area.
Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured worker and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.
Main responsibilities will include but are not limited to:
Using clinical/nursing skills to help coordinate the individual's treatment program while maximizing cost containment.
Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists. Explaining physician's and therapists' instructions, and answering any other questions the claimant may have in an effort to facilitate his/her return to work.
Working with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator's guidelines.
Researching alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinating all aspects of the individual's enrollment into the programs, and then monitors his/her progress, in an effort to maximize cost containment and minimize time away from work.
Working with employers on modifications to job duties based on medical limitations and the employees functional assessment. Helping employer rewrite a job description, when necessary and possible, in an effort to return the client to the workplace.
May provide testimony on litigated cases.
Coordinating injured workers' appointments and arranges and/or personally escorts him/her to the appointments.
Documenting and reporting all case activity is critical for accurate case management and billing procedures.
Maintaining all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case.
Preparing detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed.
Maintains phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.
Completing insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies.
Maintaining professionalism at all times despite the stressful demands of the position. Capable of maintaining close relationships among all parties involved both in person and over the phone. Must be readily available for and responsive to all parties concerned.
Acquiring and maintaining knowledge of developments in the medical case management field. Keeping abreast of local workers' compensation laws and regulations, as well as other issues related to the case management/managed care industry. This is also critically important in keeping licenses and certifications valid.
Participating in professional associations keeps the case manager informed of events in their field while establishing referral contacts.
May assist in training/orientation of new staff as requested.
Other duties may be assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Diploma, Associate or bachelors degree in nursing or bachelors degree (or higher) in a health or human services related field required. Masters level and/or advanced study in a health-related field desired.
Minimum of two (2) years full time equivalent of direct clinical care to consumers required. Workers' compensation-related experience preferred. Prior case management experience preferred.
A current, unrestricted license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; or
In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of the persons being served, that requires:
A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization;
The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and
URAC-recognized certification in case management within four (4) years of hire as a case manager
Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility. Other state licenses/certifications as required by law.
Valid driver's license required.
Experience in rehabilitation services industry, vocational/occupational/industrial nursing preferred.
Background in state workers' compensation law and practices desirable.
Excellent interpersonal skills, phone manners, and organizational skills.
Ability to set priorities and work independently.
Computer literacy required.

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