Nurse Case Manager – Worker Compensation Industry

Carlisle & Associates, a fast growing privately held company celebrating 40 years of service, is currently seeking a Medical Case Manager to cover the Nashville, TN and surrounding areas.

This is a remote, work from home opportunity with excellent benefits and competitive pay. Qualified candidate must be certified to work as a case manager in good standing with certifications to practice in the state.

The Case Manager will be responsible for assessing, planning, coordinating, implementing and evaluating injured workers throughout the case management process.

The Case Manager will serve as a liaison between insurance carriers, attorneys, medical care providers, employers and employees to facilitate the return of medically rehabilitated workers, while utilizing the most appropriate and cost-effective methods available.

Main duties will include but are not limited to :

Serves as an intermediary to interpret and educate the injured worker on his / her disability, and the treatment plan established by the case manager, physicians, and therapists.

Clarifies physician’s and therapists’ orders and responds to concerns or questions from by the injured worker regarding his / her treatment plan, process, and return to work.

Maintains professionalism when faced with the demands and stress that may be associated with the position. Capable of developing and maintaining close working relationships and communication with all parties involved in the case management process.

Must be available for and responsive to all parties concerned.

Coordinates injured workers’ appointments and arranges and / or personally attends appointments with injured worker. Utilizes clinical / nursing skills to help coordinate the individual’s treatment program while ensuring excellent, cost-effective care.

Work product is monitored daily by supervisor.

• Works with the therapists and physicians to coordinate medical assessments to develop an overall treatment plan that provides cost containment while also meeting state and other regulatory guidelines.
• Explores alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinates all aspects of the individual’s admission into the programs, and monitors his / her progress, to ensure quality and cost-effectiveness of care and minimize loss work time.
• Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.

Maintains all case documents in files ensuring a complete and detailed history of information for all parties involved in the case.

Prepares reports according to account guidelines, and case documentation for each phase of activity as it is completed.

Reports billing hours in accordance with case activity and billing practices.

• Maintains contact with all parties involved to monitor, update, and develop case activity to ensure the progress of the case.
• Completes insurance carrier reports on required basis as established by insurance companies, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies.
• Acquires and maintains knowledge of developments in the medical case management field. Keeps abreast of local workers’ compensation laws and regulations, as well as other issues related to the case management.
• Participation in professional associations keeping informed of events in the field while establishing referral contacts.
• Provide testimony on litigated cases as requested.
• Other duties may be assigned.
• Benefits :

Please make an application promptly if you are a good match for this role due to high levels of interest.

401K with employer contributions

Company Car / Stipend

Phone / Internet Stipend

Competitive Salary and Excellent benefits

Requirements :

RN license in good standing or CCM Certification if applicable

Valid Driver’s License

State Certifications where applicable

Minimum of two (2) years full time equivalent of direct clinical care. Workers’ compensation-related experience preferred.

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