Telephonic Nurse Case Manager - Maryland

Position Overview

The Telephonic Nurse Case Manager will manage assigned occupational injury cases under the direction of the Medical Director and/or Director of Nurse Case Management.

Key Responsibilities

· Performs initial history of injured worker via telephone interview. Initial telephone contact attempted within 2 Business Days of case assignment and, if needed, non-contact letter mailed within 5 Business Days of case assignment.

· Reviews injured worker’s records and enters the summary into the database including details of the injury, past medical history, physical exam, diagnosis, treatment, pertinent laboratory/ x-ray findings, medications, next follow-up appointment and any other relevant information.

· Confers with the Medical Director, Supervisor or refers to Standing Orders on all new cases.

· Confers with the Medical Director, Supervisor or Standing Orders on all proposed treatment plans, specialist referrals, surgery requests, treatment requests, or other decisions outside of licensure.

· Coordinates specialist referrals with injured worker, employer, Specialist and adjuster. Documents Reimbursement Agreements on Authorization Letters for all Specialists who have a signed Provider Service Agreement on file with and forwards a copy to the adjuster.

· Ensures contact with the injured worker after any appointment or procedure to determine medical status and/or outcome. Demonstrate progress on every case assigned at least every 30 days.

· Ensures any medical reports are forwarded to all responsible parties.

· Requests medical records from all sources which the injured worker has been treated for the injury/condition. Requests signed HIPAA from adjuster and sends with Medical Records request to all prior medical providers.

· Answers questions and provides directions to injured workers regarding medical treatment within scope of licensure.

Performance Expectations

· Maintain accurate, timely and thorough documentation of all claimant interactions.

· Communicate effectively and professionally with the team.

· Participate in regular team meetings.

· Maintain a confident, caring and professional demeanor with all injured workers and clients.

· Adheres to all federal and state laws regarding release of medical information.

· Maintains regular and predictable attendance. Routinely works an 8-hour day. Maintains accurate timekeeping records

· Attendance at all Employee meetings

· Complete training requirements within scheduled timeframe

Required Skills and Qualifications

· Exceptional organizational skills are needed. Routinely utilizes Diary to ensure timely follow up on cases. Maintains accurate and timely entry of activity into injured worker’s file via database

· Excellent interpersonal skills, communication (written and verbal) and active listening skills.

· Strong organizational skills and ability to multitask.

· High level of empathy and compassion.

· Strong computer skills.

· Ability to work independently and maintain strict confidentiality (HIPAA compliance).

Education and Experience

• Completion of nursing school program and continuing education requirements to maintain certification

• Must be licensed in state where case management services are provided.

• 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

• Prior experience in patient navigation, care coordination, case management.

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

Performance Metrics

Performance will be measured based on the following KPIs:

• Consistently meet or exceed expected performance set forth by the Director of Nursing

Work Environment & Location

• Remote/hybrid

• Reports to: Director of Nurse Case Management.

Benefits

• Competitive pay and bonus program

• Health, dental, vision, and retirement plans

• Flexible scheduling

• Nurse referral program

• Continuing education support