Nurse Case Manager - fully remote
Company: IPMG
Location: Saint Charles
Posted on: May 16, 2022
Job Description:
Job Description JOB SUMMARY Case management is a collaborative
process of assessment, planning, facilitation, and advocacy for
options and services to meet an individual's health and/or
disability needs through communication and available resources to
promote quality cost-effective outcomes. The Nurse Case Manager
handles a variety of types of case management that may include
workers' compensation, case management in the medical health plan
administration setting, as well as health management, disease
management, and absence management. ESSENTIAL FUNCTIONS
- Conducts initial and ongoing assessments to identify patient
status and individual needs; promotes client
self-determination
- Assists in identifying appropriate providers and facilities
throughout the continuum of services, while ensuring that available
resources are being used in a timely and cost-effective manner in
order to obtain optimum value for both the client and the
reimbursement source.
- Utilizes appropriate resources and case management
interventions to facilitate the case management plan and to allow
for the individual's optimum level of wellness and functional
capability with quality cost-effective outcomes appropriate to
health plan and workers' compensation
- Develops a specific case management plan in collaboration with
the consumer and members of the health care team with periodic
updates. Identifies short term goals, long term goals,
interventions to meet goals, resources to be utilized, timeframes
for re-evaluations, and collaborative approaches to facilitate the
case management plan
- Executes and documents specific case management activities
and/or interventions that will lead to accomplishing the goals set
forth in the case management plan
- Gathers sufficient information from all relevant sources and
its documentation regarding the case management plan and its
activities and/or services to enable the determination of the
plan's effectiveness
- Evaluates at appropriate intervals, determining and documenting
the case management plan's effectiveness in reaching desired
outcomes and goals with modifications, as appropriate
- Measures and modifies the interventions to determine the
outcomes of the case management involvement
- Implements care plan by facilitating authorizations and
referrals, as appropriate, within benefit structure, contractual
agreements or jurisdictional regulations; utilizing nationally
accepted evidence based criteria as guidelines for treatment
protocols
- Notifies claims personnel regarding anticipated surgeries,
benefit exceptions, and other significant events that may require
special handling
- Manages the disability durations proactively, utilizing
nationally accepted evidence-based criteria as guidelines for
duration protocols in workers' compensation and short term
disability
- Collaborates and communicates effectively with patients/injured
workers, providers, client, employers, and internal team
members
- Performs Health Management Program and Chronic Condition
/Disease Management according to protocols and standards, as
required by benefit plans.
- Performs triage intake functions with referrals and
coordination of care needs specific to client instructions.
- Performs short term disability management according to
regulations, policies, and plan documents REQUIRED QUALIFICATIONS
Registered Nurse
- 1+ years of workers' compensation case management
experience
- 2 years of clinical experience
- Excellent written and verbal communication skills
- Proven customer service skills
- Effective time management skills
- Overall computer proficiency including expertise in Microsoft
Office Suite, especially Outlook, Word, and Excel
- Licenses and Certifications
- Licensure or certification in a health or human services
discipline that allows the professional to conduct an assessment
independently as permitted within the scope of practice of the
discipline;
- Two years full-time equivalent of direct clinical care to the
consumer; and
- At least one of the following: i. Certification as a case
manager from the URAC-approved list of certifications; orii. A
bachelor's or higher degree in a health or human services related
field; or iii. A current registered nurse (RN) license 4.
Willingness to obtain advanced certification, when eligible 5.
Willingness to obtain additional state licensure, as required by
business needs PREFERRED QUALIFICATIONS
- Advanced/board certification in case management
- Additional case management/utilization review experience will
be considered SCHEDULE8:30 a.m. to 5:00 p.m. Monday through Friday.
Summer hours (Memorial Day to Labor Day) 8:00 a.m. to 5:00 p.m.
Monday through Thursday and 8:30 a.m. to 3:00 p.m. Friday. Work
from home position TRAVELOccasional travel to clients and business
partners. Valid driver's license is required.
Keywords: IPMG, Elgin , Nurse Case Manager - fully remote, Healthcare , Saint Charles, Illinois
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