Workers Compensation RN Field Case Manager Registered

Aetna   •  

Chantilly, VA

Industry: Healthcare

  •  

5 - 7 years

Posted 24 days ago

We are seeking self-motivated,energetic, detail oriented, highly organized, tech-savvy Registered Nurses tojoin our Workers' Compensation Field Case Management team. This opportunityoffers a competitive salary, full benefits, and a performance-based bonus paidout on a monthly or quarterly basis. Our organization promotes autonomy througha Monday-Friday working schedule, paid holidays, and flexibility as youcoordinate the care of your members.

LOCATION

NORTHERN VIRGINIA (CHANTILLY, FAIRFAX, TYSONS, ALEXANDRIA)


The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.


Fundamental Components:

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician's office to provide ongoing case management services.

Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.

Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.

Prepares all required documentation of case work activities as appropriate.

Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.

May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.

Provides educational and prevention information for best medical outcomes.

Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.

Testifies as required to substantiate any relevant case work or reports.

Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member's/client's overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation.


Background Experience:

5 years clinical practice experience.

3 years case management experience.

Effective computer skills including navigating multiple systems and keyboarding

Job-specific technical knowledge, (e.g., knowledge of workers compensation and disability industry for workers' compensation case managers or case management).

Ability to travel within a designated geographic area for in-person case management activities

Excellent analytical and problem solving skills

Bilingual preferred

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Ability to work independently (may require working from home).

Knowledge of laws and regulations governing delivery of rehabilitation services.

Effective communications, organizational, and interpersonal skills.



CERTIFICATIONS PREFERRED

Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required.



LICENSE REQUIRED:

Registered Nurse with active state license in good standing in the state where job duties are performed is required



EDUCATION REQUIRED

Bachelordegree in a closely-related field, or an equivalent combination of formal education and recent, related experience; preference will be given to applicants with a Master's degree


All employees are expected to

embody our values of Excellence, Integrity, Caring and Inspiration in all that

they do as an employee. The overall responsibility of the Field Case

Manager is to ensure the injured worker receives the best possible care in a

timely and efficient manner towards full rehabilitation and return to work.

Please note that we do offer mileage reimbursement for local travel.



As a Workers' Compensation Field

Case Manager, you will be offered:



Autonomy



Productivity incentives



Monday-Friday schedule



Reimbursement for mileage,

tolls, parking, licensure and certification



Laptop, iPhone &

printer/fax/scanner all in one.