Job Description

This position will cover the Allentown, PA with a travel radius of up to 2 hours.

Full- and Part-time roles available.

PRIMARY FUNCTION

The Field Nurse Case Manager is responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. The Field Nurse Case Manager is responsible for submitting timely case reports and updates to insurance claims adjusters and employers. This will ensure appropriate, related and cost-effective healthcare services.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Effectively manage assigned caseload of medical/disability cases within company and regulatory guidelines
• Communication with claimants, medical professionals, claims staff and others to obtain information necessary to make sound medical decisions. In addition, responds to various written, telephone and/or in-person inquiries regarding status of case.
• Respond to various written, telephone and/or in person inquiries regarding the status of the case
• Communication with claimants, medical professionals, claims staff and others to obtain information necessary to make sound medical decisions
• Makes case management recommendations based on physician’s recommendations by completing case evaluations, assessing injury/disability severity, treatment plans, functional abilities and physical job requirements and establishing case specific target return to work dates.
• Maintains professional standard and ethical codes of conduct as required by the license(s) and professional certification(s) held by case manager
• Applies the case management process of assessment planning implementation, coordination monitoring and evaluation
• Attend physician appointments with injured worker(s), as needed
• Complies with company’s billing practices
• Periodically assists with special projects assigned by Supervisor
• Periodically serves as a resource regarding local jurisdictional guidelines
• Performs other related duties as required

SCOPE, PURPOSE, AND FREQUENCY OF CONTACTS

Externally

• Claims Adjustors
• Employers
• Injured workers and family members
• Attorneys
• Vendors
• Treating providers to include office staff, Hospitals, pharmacy, physicians and therapist

Internally

• Corporate Staff
• Field Supervisors
• Field Nurses

DIRECTION/SUPERVISION OF OTHERS

• N/A

DIRECTION/SUPERVISION RECEIVED

• Field Case Management Supervisor

EDUCATION AND EXPERIENCE REQUIREMENTS

• 3-to-5 years clinical experience required , workers' compensation experience is a plus
• Graduate from an accredited nursing, physical therapy, occupational therapy or physician assistant school required
• Current unrestricted license in the state where the position is based and other assigned states required by law
• Preference for previous insurance / workers’ compensation case management, orthopedic, emergency room, critical care, home care or rehab care experience
• Preferably holds one of the following certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Registered Nurse (CRRN) or Certified Occupational Health Nurse (COHN)
• State-specific registrations or certification, as required by various worker’s compensation jurisdictions

KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS

• Good negotiation skills to successfully establish return to work dates and manage medical and disability treatment plans
• Attention to detail
• Strong Time management, Organizational skills and ability to multitask
• Ability to work on multiple cases at the same time
• Strong written and verbal communication skills to effectively communicate with claimant, medical professionals, employers, claims staff and others
• Written Abilities: Proficient grammar, sentence structure and written communication skills are required
• Ability to maintain confidentiality
• Proficient Computer experience required, especially Microsoft Outlook, Word and Excel
• Able to work as a team player
• Bilingual is a plus

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