JOB TITLE: MEDICAL CASE MANAGER

JOB SUMMARY:

A nurse liaison who communicates pertinent medical information among the Injured Worker, the Insured and the Carrier and who facilitates appropriate medical treatment for a successful rehabilitation outcome and work re-entry.

Provides efficient, cost effective communication relative to specific, individualized work injuries, motor vehicle accidents, liability claims, long and short term disability claims or other specialized service requested by the referral sources in a systematic manner.

DUTIES AND RESPONSIBILITIES: (include, but are not limited to) ● Follow all policies and procedures as outlined in the case management plan. ● Retain accountability for the CM plan and process

• Accept all referrals as assigned by the director of case management. ● Initial contacts made according to the case management plan
• Schedule initial assessment and obtain date of next physician appointment ● Confirm assignment with referral source and clarify special handling instructions. ● Develop appropriate working relationship with Clients.
• Maintain integrity and deal with claimants in a dignified manner ● Contact with the Carrier and Insured immediately following physician’s appointments (per referral’s protocol)
• Maintain on-going communication with Injured Worker, Insured and Carrier. ● Record appropriate data and billing in the CaseAnyplace system for reporting. ● Submit appropriate monthly reports on time (Preliminary, Initial, Progress and Closing).
• Attend physician appointments and obtain diagnosis, prognosis, treatment plan, estimated length of rehabilitation, estimated return to modified and regular duty work, MMI/Full Recovery as appropriate.
• Refer to Voc. Counselor for Job Analyses (both modified and regular duty) when appropriate and approved by Carrier.
• Recommend appropriate IME physicians to the Carriers.
• Coordinate transportation as needed.
• Provide translation for Injured Worker/Physicians; Insured as needed (Bilingual nurses)
• Coordinate and attend IMEs
• Monitor treatment plan; attend therapy sessions when appropriate. Maintain contact with therapists for updates 
• Request transfer of files to AMC Vocational Counselor when appropriate (LMS, Voc Rehab)
• Assist Carrier and Insured in transition of Injured Worker back to work with Insured (modified or regular duty)
• Provide information to Defense Attorneys as appropriate
• Promote teamwork by assisting and communicating with all AMC staff members ● Maximize accurate & appropriate billable hours per monthly target (8 hrs/day) ● Maintain licensure and certifications/ enhance knowledge by participating in Continuing Education functions
• Complete all education and training sessions in a timely manner as directed (annually)
• Perform additional professional duties as assigned
• Retain responsibility for job tasks delegated to non-clinical staff members.

JOB QUALIFICATIONS: Registered Nurse – current unrestricted state nursing license, and be licensed in each state where field case management services are provided and ability to perform an independent assessment under the scope of the licensure

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

Education: Completion of nursing school program and continuing education requirements to maintain certification.

One or more national certifications obtained within 4 years of commencing employment: CCM, CRC, CLNC, CRRN, etc preferred

Two years full time equivalent providing direct case management to the injured worker or work under a supervisor for two years preferred.