Loading some great jobs for you...
Mitchell & Genex have Merged
Mitchell is a trusted software and service provider to the Property & Casualty Claims and collision repair industries as well as risk management professionals. We provide technology and services that simplify claims handling, repair processes and pharmacy transactions with best in class clinical management and cost containment solutions. Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, reducing health care costs and disability expenses for our customers.
Together, we bring two industry leaders in software and service committed to delivering a first-class experience to the customers, partners and markets we serve. We offer a complete suite of technology enabled solutions, and a proven managed care service mix, allowing us to deliver better outcomes to our clients for their businesses, their employees and their customers.
We are hiring for a Bilingual RN Field Case Manager, which can be based remotely anywhere in the greater state of New Jersey. This job will also be required to commute locally when visiting patients, physicians and adjusters.
Individual will be responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Works as an intermediary between carriers, attorneys, medical care providers, employers and employees to ensure appropriate and cost-effective healthcare services and a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.
Main responsibilities will include but are not limited to:
Uses clinical/nursing skills to help coordinate the individual s treatment program while ensuring quality, cost-effective care. Performance is monitored daily by supervisors and/or branch managers.
Serves as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists. Explains physician s and therapists instructions, and answers any other questions the claimant may have to facilitate his/her return to work.
Works with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator s guidelines.
Researches alternative treatment programs such as pain clinics, home health care, and work hardening. Coordinates all aspects of the individual s enrollment into the programs, and then monitors his/her progress, to ensure quality and cost-effectiveness of care and minimize time away from work.
Works with employers on modifications to job duties based on medical limitations and the employee s functional assessment. Helps employer rewrite a job description, when necessary and possible, to return the client to the workplace.
May provide testimony on litigated cases.
Coordinates injured workers appointments and arranges and/or personally escorts him/her to the appointments.
Maintains all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case.
Prepares detailed evaluation reports, as per account guidelines, and case recording documenting for each phase of activity as it is completed. Reports billing hours in accordance with case activity and billing practices.
Maintains phone contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.
Compiles a case inventory monthly for submission to the branch manager to allow for proper billing and to calculate hours for bonus purposes.
Completes insurance carrier reports on a monthly (or as required) basis, as well as other necessary paperwork for the insurance company, state, or other regulatory bodies.
Maintains professionalism always despite the stressful demands of the position. Capable of maintaining close relationships among all parties involved both in person and over the phone. Must be readily available for and responsive to all parties concerned.
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/managed care industry. This is also critically important in keeping licenses and certifications valid.
Participation in professional associations keeps the case manager informed of events in their field while establishing referral contacts.
May assist in training/orientation of new staff as requested.
Monitors functions assigned to non-case managers and provides input on the performance of support staff to their supervisor.
Other duties may be assigned.
EDUCATION: Diploma, Associate or bachelors degree in nursing or bachelors degree (or higher) in a health or human services related field required. Masters level and/or advanced study in a health-related field desired.
EXPERIENCE: Minimum of two (2) years full time equivalent of direct clinical care to consumers required. Workers compensation-related experience preferred. Prior case management experience preferred.
A current, unrestricted license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; or
Launch your career - Create your profile now!Create your Profile
Loading some great jobs for you...