RN Case Manager

Job Description

Job Description

Job Title : Case Manager RN

Name of Company : Horizon Case Management

Horizon Case Management (https : / / horizonccm.com / ) is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care and cost-effective outcomes.

At Horizon Case Management, our goal is to have our clients feeling secure, empowered and improve knowing they have a professional healthcare advocate on their side.

Nurse Case Manager must be able to demonstrate and be accountable for the standards of practice policies and procedures, quality assurance and the goals of the organization.

Also, manage treatment of claimants alongside workers' compensation and auto insurance adjusters.

Duties :

• Obtains and reviews patient clinical status and history to determine casual nature of patient's symptoms as related to reported work injuries.
• Determines the medical necessity / reasonableness of proposed and ongoing treatment
• Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required.

Communicates final decision and subsequent ramifications to claim handlers.

• Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers' compensation, state, industry and division rating standards and policies, in conjunction with the claim handler.
• Uses independent judgment and discretion in identifying and planning strategies to promote effective long-term pain management and increase functioning.
• Seeks consultation from physicians, clinical and other disciplines and departments as required to expedite treatment for the work-related injury.
• With respect to the individual claimant, analyzes and evaluates the effects of case management on quality outcomes, fiscal parameters, customer satisfactions and systems operations, and develops strategies to improve performance.

Job Requirements

• Registered Nurse license active and unrestricted required. Bachelor's degree in Nursing (BSN) (preferred)
• Certified Case Management (CCM) certification or obtain within 2 years of working with the company
• Experience working with auto injury and workmens comp clients or insurance preferred
• Three years active patient or clinical care experience
• Excellent oral and written communication, customer service, written report preparation, human relations and decision-making skills are required
• Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making
• Proficient computer / office skills including Microsoft Suite
• Highly effective communications skills in English, in speaking and writing
• Able to work Monday-Friday between the hours of 8am-5pm, travel for work 50% of the time to meet clients out in the field at their doctors appointments.

Two days in-office required, 3 days in home / field.

• EOE / Minorities / Females / Veterans / Disabled
8 days ago