PT Medical Nurse Case Manager (RN)
Company: GENEX Services
Posted on: May 18, 2019
Monday, November 12, 2018
Individual will be responsible for assessment, planning,
coordination, implementation and evaluation of injured/disabled
individuals involved in the medical case management process. Works
as an intermediary between carriers, attorneys, medical care
providers, employers and employees to ensure appropriate and
cost-effective healthcare services and a medically rehabilitated
individual who is ready to return to an optimal level of work and
Main responsibilities will include but are not limited to:
-- Uses clinical/nursing skills to help coordinate the individual's
treatment program while ensuring quality, cost-effective care.
Performance is monitored daily by supervisors and/or branch
-- Serves as an intermediary to interpret and educate the
individual on his/her disability, and the treatment plan
established by the case manager, physicians, and therapists.
Explains physician's and therapists' instructions, and answers any
other questions the claimant may have to facilitate his/her return
-- Works with the physicians and therapists to set up medical
assessments to develop an overall treatment plan that ensures cost
containment while meeting state and other regulator's
-- Researches alternative treatment programs such as pain clinics,
home health care, and work hardening. Coordinates all aspects of
the individual's enrollment into the programs, and then monitors
his/her progress, to ensure quality and cost-effectiveness of care
and minimize time away from work.
-- Works with employers on modifications to job duties based on
medical limitations and the employee's functional assessment. Helps
employer rewrite a job description, when necessary and possible, to
return the client to the workplace.
-- May provide testimony on litigated cases.
-- Coordinates injured workers' appointments and arranges and/or
personally escorts him/her to the appointments.
-- Maintains all case documents in files ensuring a comprehensive
and detailed source of information for all parties involved in the
-- Prepares detailed evaluation reports, as per account guidelines,
and case recording documenting for each phase of activity as it is
completed. Reports billing hours in accordance with case activity
and billing practices.
-- Maintains phone contact with all parties involved to monitor,
update, and advance case activity to ensure the progress of the
-- Compiles a case inventory monthly for submission to the branch
manager to allow for proper billing and to calculate hours for
-- Completes insurance carrier reports on a monthly (or as
required) basis, as well as other necessary paperwork for the
insurance company, state, or other regulatory bodies.
-- Maintains professionalism always despite the stressful demands
of the position. Capable of maintaining close relationships among
all parties involved both in person and over the phone. Must be
readily available for and responsive to all parties concerned.
-- Acquires and maintains knowledge of developments in the medical
case management field. Keeps abreast of local workers' compensation
laws and regulations, as well as other issues related to the case
management/managed care industry. This is also critically important
in keeping licenses and certifications valid.
-- Participation in professional associations keeps the case
manager informed of events in their field while establishing
-- May assist in training/orientation of new staff as
-- Monitors functions assigned to non-case managers and provides
input on the performance of support staff to their supervisor.
-- Other duties may be assigned.
EDUCATION:--Diploma, Associate or bachelors degree in nursing or
bachelors degree (or higher) in a health or human services related
field--required. Masters level and/or advanced study in a
health-related field desired.
EXPERIENCE:--Minimum of two (2) years full time equivalent of
direct clinical care to consumers--required. Workers'
compensation-related experience preferred. Prior case management
-- A current, unrestricted license or certification to 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; or
-- In the case of an individual in a state that does not require
licensure or certification, the individual must have a
baccalaureate or graduate degree in social work, or another health
or human services field that promotes the physical, psychosocial,
and/or vocational well-being of the persons being served, that
-- A degree from an institution that is fully accredited by a
nationally recognized educational accreditation organization;
-- The individual must have completed a supervised field
experience, in case management, health, or behavioral health as
part of the degree requirements; and
-- URAC-recognized certification in case management within four (4)
years of hire as a case manage
CERTIFICATES, LICENSES, REGISTRATIONS:--See minimum Qualifications
above. Pursue URAC-recognized certification in case management
(CCM, CDMS, CRC, CRRN or COHN) upon eligibility. Other state
licenses/certifications as required by law. Valid driver's license
OTHER QUALIFICATIONS:--Experience in rehabilitation services
industry, vocational/occupational/industrial nursing preferred.
Background in state workers' compensation law and practices
desirable. Excellent interpersonal skills and phone manners.
Excellent organizational skills. Ability to set priorities. Ability
to work independently. Computer literacy required.
Genex is an equal opportunity, at-will employer and does not
discriminate against any employee or applicant for employment
because of age, race, religion, color, disability, sex, sexual
orientation or national origin.
Keywords: GENEX Services, Beaumont , PT Medical Nurse Case Manager (RN), Executive , Beaumont, Texas
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