Genex Services Telephonic Nurse Case Manager (RN) in Memphis, Tennessee
We are currently seeking a Telephonic Nurse Case Manager (RN).
Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured worker and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.
Main responsibilities will include but are not limited to:
Using clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality of care and cost containment.
Performing three-point contacts:
o Contact employee: expressing your and the employer’s concern for the employee’s health; educating the employee in company policies and regulations; supporting employee in complying with prescribed treatment plan; assessing employee motivation and resources (personal and interpersonal) that support return to work; and establishing and maintaining Case Management goals and expectations of return to work in a safe and timely manner with the employee.
o Contact provider: identifying yourself and explaining your role; ascertaining treatment plan in order to assist patient compliance; requesting reports if appropriate; and determining return to clinic date, referrals and projected return-to-work date.
o Contact employer/adjuster/insurer: providing diagnosis, therapy, providers and projected return-to-work date; providing hard copy follow-up within 72 hours of original contact date; and reviewing with employer the employee and provider’s concerns.
Objectively and critically assessing all information related to the current treatment plan to identify barriers, clarifying or determining realistic goals and objectives, and seeking potential alternatives.
Maintaining daily records of all contacts.
Generating and faxing, if requested, Initial or 72-hour report, including appropriateness of treatment plan and Case Management recommendations.
Serving 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 in an effort to facilitate his/her return to work.
Working 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.
Researching alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinating all aspects of the individual’s enrollment into the programs, and then monitors his/her progress, in an effort to maximize cost containment and minimize time away from work.
Working with employers on modifications to job duties based on medical limitations and the employees functional assessment. Helping employer rewrite a job description, when necessary and possible, in an effort to return the client to the workplace.
Monitoring/evaluating the employee’s progress.
Supplying employer/adjuster/insurer with periodic reports agreed to in original contract, but not less than biweekly.
Providing input on the performance of support staff to their supervisor.
Tracking client updates by use of daily open listing.
Attending scheduled staff meetings and in-service programs.
Other duties as assigned.
Maintaining the necessary credentials and demonstrating a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole.
Maintains professionalism at all times 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.
Acquiring and maintaining knowledge of developments in the medical case management field. Keeping abreast of local workers’ compensation laws and regulations, as well as other issues in the case management field. This is also critically important in keeping licenses and certifications valid.
Seeking professional certification and participation in professional associations keeps the case manager informed of events in their field while establishing referral contacts.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
Diploma, A.S. degree or B.S. degree in nursing required. Advanced Degree preferred.
Minimum of two (2) years full time equivalent of direct clinical care to consumers/clinical practice.
Case Management and Workers’ compensation-related experience preferred.
Registered nurse with current, valid state licensure required.
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:
1) A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization;
2) The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and
3) URAC-recognized certification in case management within four (4) years of hire as a case manager
Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility. Other state licenses/certification as required by law.
Prior Case Management experience preferred.
Excellent interpersonal skills and phone manners. Excellent organizational skills.
Ability to set priorities. Ability to work independently and as part of a team.
Computer literacy required.
Job ID 2017-1549
Job Locations US-TN-Memphis
Category Telephonic Case Management