PRIMARY PURPOSE: To facilitate progressive medical treatment/rehabilitation and/or timely return to work of injured worker; and to act as liaison for involved parties.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Assesses and analyzes injured worker's medical and vocational status.
- Develops progressive plan of care to facilitate medical recovery and progressive return to work.
- Manages one-time task assignment or full field case management referral to meet with attending physician, injured worker and/or employer to clarify medical and/or vocational claim related information which could not be obtained through correspondence or telephonic attempts by claims team.
- Collaborates with members of the health care team to provide ongoing case management services.
- Acts as liaison for involved parties in the worker's compensation injury by communicating in person and telephonically with the patient/caregiver, attorneys, employer, claims examiners, telephonic nurse case manager, return to work specialists, vocational rehabilitation supervisor, provider(s), ancillary provider(s) and health care team.
- Monitors injured employee's progress towards appropriately established outcomes through continued assessment and evaluation.
- Coordinates necessary referrals, consultations, and therapeutic services for the injured employee.
- Completes the interview process with the patient/caregiver in the home, worksite, ancillary location or physician's office for current and ongoing assessments and evaluations.
- Assists in the development of continued care plans as necessary to include patient education and prevention programs.
- Testifies as needed to substantiate relevant case work or reports.
- Confers with medical treating providers concerning the course of care and treatment per clinical guidelines.
- Educates medical providers on appropriate disability and treatment guidelines as necessary.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the total performance management initiative.
- Travels as required.
- Works from home as needed.
Education & Licensing
Current state RN licensure required. Bachelor's degree or equivalent experience preferred. CCM, CRRN, COHN, CDMS eligibility or current certification preferred.
Six (6) years of related work experience or equivalent combination of education and experience required to include three (3) years case management experience.
Skills & Knowledge
Knowledge of laws and regulations pertaining to rehabilitation and HIPPA
Knowledge of workers' compensation and/or disability
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Strong problem solving skills
Ability to work independently
Excellent interpersonal and negotiation skills
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required