RN Case Manager 8/10/2016

ALT Orange, CA

Company
ALT
Job Classification
Full Time
Company Ref #
28703446
AJE Ref #
575844423
Location
Orange, CA
Job Type
Regular

JOB DESCRIPTION

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SUMMARY

This position requires an individual experienced in Workers' Compensation, Case Management and Utilization Review, and other similar services, who, under minimal supervision can independently analyze incoming referrals, communicate at a clinical level with all clients, providers, claims examiners, and other stakeholders to a claim, while meeting contracted client requirements, and state regulatory requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES includes the following:

* Working to provide direct support to Physicians conducting various services in support of the claim
* Obtaining and Assessing necessary medicals for appropriate product needs; utilization review, pharmaceutical, discharge planning
* Coordinating essential workflow with Pharmacy Benefit Management partnerships, and other designated service vendors
* Collaborating with Utilization Review team for seamless processes in maintaining jurisdictional requirements
* Serving as active team member in URAC accreditation responsibilities, as needed
* Functioning to provide quality driven data entries for various clinical products
* Utilizing a multi-disciplinary team approach to achieve client satisfaction
* Assist the Medical Director and AVP of Clinical Services in directing service outcomes

QUALIFICATIONS

* Experience in the Workers' Compensation arena; and understanding of Evidence Based Criteria
* Strong Organizational skills; able to work independently; and able to prioritize projects to meet necessary deadlines
* Ability to identify and resolve problems in a timely manner, while able to gather and analyze information.
* Ability to demonstrate accuracy and thoroughness, monitor own work to ensure quality and apply feedback to improve performance
* Good Communication skills; problem solving; and critical thinking
* Ability to mentor other non clinical team members to assist in growth and learning within the department

OTHER NEEDED SKILLS

Detail oriented

Strong organizational skills

Ability to multi-task

Proficiency in Keyboard, windows, and other software programs

Excellent written and verbal communication skills

EDUCATION AND EXPERIENCE

Current unrestricted Nursing License

College education, Bachelor's Degreepreferred

5 years or more Workers' Compensation experience, with an emphasis in the Case Management arena

LANGUAGE SKILLS

English required, bilingual preferred

MATHEMATICAL SKILLS

Some college level of math preferred