Case Management Nurse

Job Description

Spooner Medical Administrators, Incorporated (SMAI) is a family owned and operated company that offers rewarding career opportunities for motivated individuals who are passionate about excellence and growth. Since 1997, SMAI’s proactive philosophy and best practices have set the standard in workers’ compensation by continuously improving the delivery of case management, utilization review and billing services to help facilitate a successful return to work for the injured worker.

The Case Manager is primarily responsible for coordinating and facilitating medical and rehabilitation services to assist injured workers in obtaining their pre-injury status, maximum medical improvement and / or return to work.

Essential Functions

— Initiate telephonic contact with the injured worker, physician of record and employer to perform an assessment and obtain information regarding the work injury and return to work options.

— Develop a written case management plan that addresses the injured workers’ needs, short and long term goals and any psychological issues that may arise as a result of the injury.

— Monitor the case management plan and coordinate any additional resources to further the plan’s success including referrals to vocational rehabilitation when applicable.

— Work in conjunction with the Utilization Review department to coordinate services where appropriate and make determinations regarding the need for alternative treatment or services necessary to move the case towards a return to work.

— Use critical thinking skills and problem solving techniques throughout the case management process and provide assistance to injured workers’ with disabilities or barriers.

— Serve as an advocate for the injured worker while coordinating services with the employer, provider and any additional parties to the claim.

— Participate in some On-Site Case Management activities to address the injured workers’ needs.

— Participate in continuous improvement activities and other assigned duties as assigned.

Supervision Received

Reports to the Case Management Supervisor

Experience and Education Required

— Current, unrestricted Ohio RN licensure or one of the following case management certifications : CCM, CDMS, CRC, RN C, RN BC, CRRN, COHN

— Minimum of 2 years post-graduate experience in direct patient care

— General working knowledge of the medical / vocational case management process including medical terminology, clinical pharmacology and acute / chronic disability or illness

— Ability to establish a working relationship with medical providers and employers

— Ability to travel for work

Additional Skills Needed

— Effective written and verbal communication

— Detail oriented

— Strong organizational ability

— Basic computer literacy skills

Working Environment

The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of the job. While performing the duties of this job, the employee typically works in a normal office environment. The noise level in the work environment is usually quiet.