Worker's Compensation RN Case Manager - Telephonic
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POST DATE 8/8/2016
END DATE 11/9/2016
Huntington Beach, CA
JOB DESCRIPTIONAPPLY This Worker's Compensation RN Case Manager Position Features:
? Great Pay Up to $82K
? Flexible Work Schedule-Remote Work from Home
? An Awesome well established company
Immediate need for Worker's Compensation RN-Telephonic Case Manager
Telephonic Nurse Case Management (home based) with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution. Contact medical provider and employees on claims involving medical treatment and/or disability to coordinate appropriate medical care. Develop medical management strategy and give the provider information necessary to facilitate a return-to-work plan, within established protocols. Work with medical providers and suggest cost effective treatment alternatives, when appropriate. Help ensure that all injured employees are on an aggressive treatment plan. Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by the claims examiner and within state guidelines. Perform Utilization Review according to established guidelines. Utilize physician advisor program. Proactively manage the medical expenses by partnering with specialty resources to achieve appropriate claim outcomes. Obtain medical records from providers telephonically during initial contact, and follow up with written correspondence if necessary. Discuss medical information and disability status with claims examiner and integrate into overall strategy to ensure appropriateness of indemnity payments. Provide technical assistance and act as a resource for claims handling staff. Work with claims examiner to initiate modified duty or full return o work. Obtain job description and discuss job modifications required to ensure a prompt return to work. Nurse Case manager will work with claims examiner, injured employee and medical provider to expedite return to work. Document all contacts and outcomes related to case activity in the claim system. Timely and regularly submit billing on all activities per established guidelines. Provide feedback regarding PPO/MPN providers that would include possible additions/removals.
Comply with established Best Practices. Perform other duties as needed.
Required: MUST HAVE RN LICENSE
Disability Case Management experience Required
Strong Written and Verbal Skills
Understanding of Worker's Compensation Laws or Auto First Party Medical
We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.
Computer and Telephone Skills Required
CDMS, CRC, CCM CRRN desirable.