Experienced Remote California Licensed Telephonic RN Workers Compensation Nurse Case Managers Needed ($90,000 to $95,000 Per Year) Plus Excellent Benefits As a Telephonic RN Worker’s Compensation Nurse Case Manager, you will be responsible for providing comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider, employer and claims adjuster.
Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessaryResponsible for accurate comprehensive documentation of case management activities in case management system.Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.Addresses need for job description and appropriately discusses with employer, injured employee and/or provider.
Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client’s situation to include psychosocial needs, cultural implications and support systems in placeObjectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcomeEvaluate and update treatment and return to work plans within established protocols throughout the life of the claim.Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reservesMay assist in training/orientation of new staff as requested Education & Licensing Active unrestricted California RN license is required.Bachelor’s degree in nursing (BSN) is preferred.Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
5+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required.
National Certification in case management OR the ability to obtain certification within 24 months of employment is required.
Skills & KnowledgeKnowledge of workers’ compensation laws and regulations Knowledge of case management practice Knowledge of the nature and extent of injuries, periods of disability, and treatment needed Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation Knowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation skills What We OfferWe offer a competitive compensation package and excellent career advancement opportunities.
Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children Health Care Flexible Spending, Dependent Care, 401k Savings Plans and Paid Time Off.
If you or anyone you know is interested, qualified and currently seeking employment please send an updated resume to us for immediate review and consideration.