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Medical Nurse Case Manager
at GENEX Services
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 managers.
• 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 to work.
• 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 guidelines.
• 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 case.
• 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 case.
• Compiles a case inventory monthly for submission to the branch manager to allow for proper billing and to calculate hours for bonus purposes.
• 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 referral contacts.
• May assist in training/orientation of new staff as requested.
• 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 experience preferred.
• 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 requires:
• 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 required
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.
Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, while reducing health care costs and disability expenses for our customers. At the heart of our success are more than 2,900 medical and business professionals who “make it count” by providing comprehensive care management and multicultural services from locations across the United States and Canada. Our dedicated team serves more than 380 of the Fortune 500 companies as well as the top workers’ compensation and disability carriers and third-party administrators in the U.S. In addition, Genex is the only company that delivers high-quality clinical services enhanced by intelligent systems and 360-degree data analysis to consistently drive superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems.
We attract and retain the industry’s best talent at every Genex location because we invest in our team. We offer our employees and their families benefits that provide protection and enhance quality of life. Genex’s comprehensive compensation and benefits program includes competitive salary and incentive program, medical, dental, life and LTD insurance, 401(k) with company match plus 100 percent vesting after 90 days, and a flexible work schedule. In addition, we offer a continuing education program accredited by the certifying boards for CCM, CRC and CDMS for our nursing and vocational positions.
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