Nurse Consultant Telephonic Case Management

Medical Management Specialist

Provides medical management to workers compensation injured employees. Performs case management through telephonic contact with all medical providers, employers, claims professionals and ancillary service providers. Manages medical care in order to return injured employee to preinjury status. Reviews services of medical and rehabilitation providers and arranges for and coordinates appropriate evaluation, treatment, and counseling. Communicates with physician, injured worker, employer, referral source, and any other resource involved in worker's rehabilitation program. Evaluates home care services and equipment and determines need for home modifications. Coordinates home care. Communicates with employers to determine job requirements of pre-injury occupation and to explore light-duty, modified, or alternate employment as necessary. Analyzes results of treatment and medical status and reviews incoming provider reports. Identifies suitable employment opportunities consistent with individual's medical limitations/capabilities, aptitudes, and interests to restore individual to maximum independence. Generates reports to referral source to communicate case status, findings, and recommendations. Generates correspondence to referral source, medical providers, injured worker and other parties involved in the rehabilitation process. Participates in case conferences over the telephone, and participates in internal and external training to enhance and maintain medical proficiency. Documents case management observations, assessment, and plan in system. Must maintain a case load to support at minimum 145 hours of billable or inventory of minimum of 72 files monthly with 95% quality compliance expected.