SGS-Medical Case Manager

Job title- Medical Case Manager

Location- Remote

Duration- 6 months

Job Summary :

The Medical Case Manager (ClientM) is a Registered Nurse and may also be referenced as the Nurse Case Manager (NCM). The ClientM implements integrated medical disability case management services with the goal of preventing, minimizing, or overcoming disability. The ClientM provides medical expertise and serves as the critical communication link between the parties involved in any medical disability case. The ClientM emphasizes returning medically-able individuals to productive service. The ClientM ensures timely interventions and facilitates continuous communication while providing patient advocacy through supporting patient choices. As a Registered Nurse, the ClientM, provides a professional nursing approach to case management through the Nursing Process involving : Assessment, Planning, Implementation, Monitoring, and Evaluation. The ClientM is sensitive to the importance of productive work and sees a return to work as the key outcome. Job Description Essential Functions Duties and Responsibilities

• Responsible for coordinating the treatment pathways of those claims that meet the internal case management criteria, including setting the appropriate treatment plan and other activities that meet an injured worker's / employee's health and return-to-work needs or other productive activity.
• Understands and implements criteria for identifying individuals for case management services
• Coordinates case management plans and activities with the human resources department of the injured worker / employee, as appropriate
• Solicits the employee's interest and consent, if necessary, for participation in case management activities and documents oral and / or written consent
• Documents a case management plan specific to the injured worker / employee that includes short and long term goals with timeframes, timeframes for re-evaluation, resources to be utilized, and collaborative approaches to be used (including physician participation)
• Conducts and documents an assessment of each injured worker / employee including (as appropriate) health status, treatment plan, financial resources for health care, psychosocial status, consumer knowledge, education needs in relation to health status and treatment plan, past relevant history, and possible non-medical impediments to successful resolution
• Responsible for managing the disability duration of an injured worker / employee and focus on return to work opportunities or other productive activity, including working with medical providers to identify an estimated return to modified duty, vocational rehabilitation, release from care, or actual return-to-work date
• Collaborates and clearly communicates with the injured worker / employee, family members, providers, employer, or the employer's representative in the execution of a plan for return-to-work or other productive activity.
• Identifies and obtains any required or outstanding medical documentation in support of the individual's plan for a return-to-work or other productive activity.
• Understands and implements criteria for discharge of injured worker / employee or termination of case management services
• Promotes goodwill by assisting all involved parties on issues related to the injured worker / employee, provider relations, and OWCP coordination, as applicable.
• Identifies, evaluates, and recommends strategies for claims where vocational rehabilitation services may produce an eventual return-to-work; interfaces with vocational rehabilitation or other specialties as appropriate and applicable.
• Understands the organization's quality management program and the case manager's role within that program
• Experience with Federal Employee Compensation Act (FECA) and FECA related issues preferable, as applicable for assigned account(s).
• Is an effective team member; supports the team by pitching in at any level and effectively working across the organization to meet the needs of the business
• Takes ownership of personal actions and outcomes; encourages and empowers others to do the same
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change
• Ability to work independently, multitask, and adjust priorities
• Proactively seeks opportunities to increase knowledge, skills and abilities
• May perform other duties, as needed, to meet the needs of the business Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee frequently is required to use the fingers to make small movements such as typing, picking up small objects, or pinching fingers together The employee is occasionally required to walk; reach with hands and arms; stoop, kneel, crouch, or crawl. Sedentary work. Sitting most of the time. Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and the ability to adjust focus. The employee moves within the facility in which their office is located to access file cabinets, documents, office machinery, and other equipment. They also travel within their home office or facility in which their office is located and to locations outside of the facility, to attend meetings, training, events, and other business activities. An employee in this position may lift, carry, push, and / or pull objects weighing up to 10 lbs. Occasionally but rarely may move objects weighing up to 20 lbs. The employee holding this position must have strong communication and organizational skills, and an ability to interact and work with others. They must be able to work under time constraints and deadlines. Job SpecificationsRequirements :

6 month assignment, not confirmed yet if there are extensions

100% Remote, Shifts are 8 : 30 AM - 5 : 30 PM (1 hour lunch) in the temp's local time zone - No weekend shifts

References, background, and credit through Sterling : BG CHECK PACAKGE - STERLING MANAGED CARE ADVISORS PACKAGE, must also meet Minimum IT requirement speed test (attachment). We need to have a record of RN Licenses for all Medical Case Managers submitted with their new hire paperwork.

Job Specifications

Education

Bachelors in Science Nursing or Associate in Nursing (ASN) or Nursing Diploma.

Certification

The Medical Case Manager role does require an active RN license in the state they live in and must be a ..

National certification in case management or related field preferred

License

Unrestricted Current State Registered Nurse License, We need to have a record of RN Licenses for all Medical Case Managers submitted with their new hire paperwork.

Experience

3 years of clinical experience as a Registered Nurse

2 years experience in medical case management, discharge planning, utilization review / management to determine the necessity of medical services, occupational health, and / or comparable field

Experience in Behavioral Health Chronic Medical Conditions or Oncology preferred,

Communication Skills :

Excellent verbal, written, and interpersonal communication skills, organizational and analytical skills. Superior customer service skills working proactively and collaboratively with client colleagues and client leaders, medical staff, and co-workers. Ability to effectively present information. Excellent team player; ability to partner with internal and external clients and other cross-functional departments. Superior writing and communication skills. Must write succinctly and clearly and explain complex situations in plain English to technical and non-technical audiences. Utilizes direct communication and proactive problem solving to address challenges and disagreements.

Reasoning Ability :

Ability to apply logical thinking to a wide range of intellectual and practical problems. Able to deal with very difficult concepts and complex variables. Ability to comprehend, analyze, and interpret documents. Ability to solve problems involving several options in situations. Requires intermediate analytical and quantitative skills.

Other Skills and Abilities, Qualifications

Proficiency in Microsoft Office

Coordination and Service Delivery

Appreciate and comply with all confidentiality requirements

Be proficient in how to obtain and document an accurate medical history

Be skilled in developing treatment plans with realistic goals

Understand information systems and data management

Physical and Psychological Factors

Understand the physical and psychological characteristics of illness and be familiar with methods for assessing an individual's level of impairment

Be capable of assisting individuals with the development of short- and long-term goals for recovery

Case Management Concepts

Be educated in current protocols and procedures for case management related to the WTC-NPN environment

Have an understanding and appreciation for nationally recognized standards of the case management process, particularly in regard to long-term medical conditions

Community Resources

Access and evaluate available resources and develop additional resources as the need arises

Maintain relationship with WTC-NPN team, including representatives of claims, call center, and network

Conditions of Employment

Other Requirements :

Ability to travel on occasion.

Work Environment :

The work environment characteristics are representative of those a colleague encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Persons holding office positions are generally subject to inside environmental conditions having the lighting, temperature, and noise of an open-floor-plan office environment.

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