RN Case Manager

Job Description

Job Description

Job Summary:  The Case Manager serves as the primary clinical contact for injured workers, coordinating care and facilitating safe, timely return-to-work outcomes. This role involves assessing treatment plans, collaborating with medical providers, employers, and insurers, and ensuring quality, compliance, and effective communication across all parties. The Case Manager must exercise strong clinical judgment, organizational skills, and maintain confidentiality.

QUALIFICATIONS:

• A current, unrestricted Ohio state 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
• Eligibility to hold a multi-state licenses as needed to meet the needs of the company
• Two years full-time equivalent of direct clinical care to the consumer and
• Prefer a minimum of one (1) year of active case management experience in worker's compensation
• Maintains continuing education as required to maintain licensure and certification
• Excellent leadership, verbal/written communication skills, strong organizational skills, and excellent decision making and judgment

ROLE AND RESPONSIBILITIES FOR THE CASE MANAGER:

• Reports directly to The Case Management Team Lead
• Serve as the first point of post-injury contact after triage, developing and managing return to work opportunities with injured workers, designated network providers, and employer contacts
• Assess the appropriateness of the level of care, diagnostic tests and clinical procedures for utilization review on a concurrent basis
• Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion
• Assess quality and clinical risk issues on a concurrent basis; report any recognized issue to the Case Management Team Lead
• Assess documentation of medical records for completeness on a concurrent basis
• Ability to obtain and interpret information appropriate to injured workers' needs as required for assessment, treatment, and patient care services
• Assess, develop, implement and monitor plan of care;
• Initiate communication and consistently communicate with the injured worker, employer, provider, BWC, and TPA (five-point contact, which could include attorney for IW/employer)
• Provide education and guidance to all parties to the claim; this includes: claim review at staffings, and/or providing direction to any member of the five-point contact
• Develop and maintain a positive work atmosphere and support overall team; demonstrate ability to work within a team structure
• Practice capable and effective problem identification and resolution skills as a method of sound decision making
• Maintain confidentiality
• Work independently, efficiently, and deal with priorities
• Understand and uphold UniComp philosophy and demonstrate commitment to UniComp's core values: have a sense of urgency, be optimistic, promote independence, and respect human dignity
• Perform other duties as assigned
• Practice nursing within the Scope of Practice as designated by the State of Ohio Board of Nursing
• Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.