Workers Compensation Field Case Manager RN

Employment Type

: Full-Time


: Healthcare - Nursing

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Req ID: 67603BR Job Description The Case Manager uses 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 quality, cost effective outcomes. Fundamental Components included but are not limited to: - Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. - Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. - Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician s office to provide ongoing case management services. - Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. - Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. - Prepares all required documentation of case work activities as appropriate.Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. - May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.Provides educational and prevention information for best medical outcomes. - Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. - Conducts an evaluation of members/clients needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. - Utilizes case management processes in compliance with regulatory and company policies and procedures. - Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. - Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member s/client s overall wellness through integration. - Monitors member/client progress toward desired outcomes through assessment and evaluation. Qualifications Requirements and Preferences: Required Skills/Experience: - 3+ years clinical practice experience - Registered Nurse with active state license in good standing in the state where job duties are performed - Ability to travel within a designated geographic area for in-person case management activities - Excellent analytical and problem solving skills ​- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications - Effective computer skills including navigating multiple systems and keyboarding - Associate's degree in Nursing Preferred Skills/Experience: - Bilingual preferred - 3+ years of case management experience - Ability to work independently - Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) - Knowledge of laws and regulations governing delivery of rehabilitation services. - Effective communications, organizational, and interpersonal skills. - Job-specific technical knowledge (e.g., knowledge of workers compensation and disability industry for workers compensation case managers or case management) - Bachelor's and/or Master's degree in Nursing or related field Licenses/Certifications: Nursing - Registered Nurse Functional Skills: Clinical / Medical - Disability Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Additional Job Information: RN license Benefit Eligibility Benefit eligibility may vary by position. Job Function: Healthcare Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status. </script>

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