[Hiring] Telephonic Nurse Case Manager @Athens Administrators

Role Description

Athens Administrators has an immediate need for a full-time Telephonic Nurse Case Manager to support our Managed Care Department. The position can be located remotely from California, Colorado, Nevada, Texas, Oregon, Idaho, Arizona, or Oklahoma if technical requirements are met. This position will work M-F from 9am to 5pm Pacific time schedule regardless of time zone.

The Telephonic Nurse Case Manager researches and recommends resources and creates flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate. This position will assist the unit in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training.

Primary Responsibilities

• Organizes and reviews medical records to identify specific medical issues; provides information and recommendations to appropriate parties.
• Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services.
• Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers.
• Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
• Assists the treating physician in developing a written treatment plan for the injured worker.
• Works with medical providers to track progress and modify the treatment plan as necessary.
• Obtains medical reports and required work status forms; ensures all parties receive appropriate reports.
• Develops Independent Medical Evaluation Plan; provides assessment, planning, implementation, and evaluation of patient's progress.
• Facilitates authorization/certification of procedures, diagnostic testing, and durable medical equipment.
• Cooperates with the treating physician to obtain a full or conditional release to return to work.
• Assesses the injured worker and their support system; makes appropriate referrals throughout the continuum of care.
• Coordinates with the employer to develop a modified duty job for the injured worker.
• Educates the employer on the benefits of accommodating the injured worker.
• Provides vocational services to the injured worker when a return to work with the same employer is not possible.
• Researches medical and community resources for patients with catastrophic or chronic diagnoses.
• Maintains constant contact with the adjuster assigned to the file.
• Respects the limits of decision-making authority delegated by the adjuster.
• Maintains continuing education requirements per state license requirements.
• May be requested to attend doctor and/or attorney visits for the purpose of determining appropriateness of care.
• Assists the overall unit with development of workflows, best practices, reporting templates, and training needs.
• Requires regular and consistent attendance.
• May be asked to travel to other branches for training or file reviews as needed.
• Complies with all safety rules and regulations during work hours.

Qualifications

• A Master's or Bachelor's degree in nursing or an Associate's Degree in Nursing from an accredited school, along with equivalent work experience, is required.
• CCM, CIRS, CRRN, COHN or other related designation preferred.
• Active RN license from any US state required at time of hire.
• Current RN licensure in CA required within one year of hire.
• 3+ years’ workers’ compensation case management experience or related field required.
• Fluency in Spanish preferred.
• Strong clinical background in orthopedics, neurology, or rehabilitation useful.
• Strong cost containment background, such as utilization review or managed care also useful.
• Extensive clear and tactful communications required.
• Strong negotiation skills.
• Well-developed verbal and written communication skills with strong attention to detail.
• Excellent organizational skills and ability to multi-task.
• Proficient in Microsoft Office Suite.
• Ability to learn additional computer programs.
• Ability to be trustworthy, dependable, and team-oriented.
• Acts with integrity in difficult or challenging situations.

Requirements

• Ability to type quickly, accurately and for prolonged periods.
• Ability to use a computer mouse, touchpad, or other input device frequently and for prolonged periods.
• Reasoning ability, including problem-solving and analytical skills.
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results.
• Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner.

Benefits

• Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options.
• 401k (and Roth), Company-Paid STD & LTD.
• Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments.

Company Description

Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.”