Telephonic Nurse Case Manager - Maryland

Position Overview The Telephonic Nurse Case Manager will manage assigned occupational injury cases under the direction of the Medical Director and/or Director of Nurse Case Management. Key Responsibilities Performs initial history of injured worker via telephone interview. Initial telephone contact attempted within 2 Business Days of case assignment and, if needed, non-contact letter mailed within 5 Business Days of case assignment. Reviews injured worker’s records and enters the summary into the database including details of the injury, past medical history, physical exam, diagnosis, treatment, pertinent laboratory/ x-ray findings, medications, next follow-up appointment and any other relevant information. Confers with the Medical Director, Supervisor or refers to Standing Orders on all new cases. Confers with the Medical Director, Supervisor or Standing Orders on all proposed treatment plans, specialist referrals, surgery requests, treatment requests, or other decisions outside of licensure. Coordinates specialist referrals with injured worker, employer, Specialist and adjuster. Documents Reimbursement Agreements on Authorization Letters for all Specialists who have a signed Provider Service Agreement on file with and forwards a copy to the adjuster. Ensures contact with the injured worker after any appointment or procedure to determine medical status and/or outcome. Demonstrate progress on every case assigned at least every 30 days. Ensures any medical reports are forwarded to all responsible parties. Requests medical records from all sources which the injured worker has been treated for the injury/condition. Requests signed HIPAA from adjuster and sends with Medical Records request to all prior medical providers. Answers questions and provides directions to injured workers regarding medical treatment within scope of licensure. Performance Expectations Maintain accurate, timely and thorough documentation of all claimant interactions. Communicate effectively and professionally with the team. Participate in regular team meetings. Maintain a confident, caring and professional demeanor with all injured workers and clients. Adheres to all federal and state laws regarding release of medical information. Maintains regular and predictable attendance. Routinely works an 8-hour day. Maintains accurate timekeeping records. Attendance at all Employee meetings. Complete training requirements within scheduled timeframe. Required Skills and Qualifications Exceptional organizational skills are needed. Routinely utilizes Diary to ensure timely follow up on cases. Maintains accurate and timely entry of activity into injured worker’s file via database. Excellent interpersonal skills, communication (written and verbal) and active listening skills. Strong organizational skills and ability to multitask. High level of empathy and compassion. Strong computer skills. Ability to work independently and maintain strict confidentiality (HIPAA compliance). Education and Experience Completion of nursing school program and continuing education requirements to maintain certification. Must be licensed in state where case management services are provided. 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. Prior experience in patient navigation, care coordination, case management. Two years full-time equivalent providing direct case management to the injured worker or work under a supervisor for two years preferred. Performance Metrics Performance will be measured based on the following KPIs: Consistently meet or exceed expected performance set forth by the Director of Nursing. Work Environment & Location Remote/hybrid Reports to: Director of Nurse Case Management. Benefits Competitive pay and bonus program Health, dental, vision, and retirement plans Flexible scheduling Nurse referral program Continuing education support #J-18808-Ljbffr