Remote Case Manager; RN

Overview

CORE Health Networks, the recognized leader in Integrated Occupational Medicine Services, provides integrated solutions to your occupational healthcare needs. We are currently seeking a full-time Case Manager (Registered Nurse) to work from home Monday through Friday from 8:30am to 5:00pm, Central Time.

We offer a highly competitive total compensation package which includes Health, Dental, Vision, Life, 401(k), Six Paid Holidays, Vacation and Sick Leave, Long-term disability and short-term disability benefits, and much more.

Under the direction of the Director of Injury Management, the Case Manager administers the intake of calls from contracted clients, an injured worker, Worker’s Compensation Insurance adjusters, Medical providers, and clinic staff. Provides exceptional service and quality treatment options to the patient and client throughout the injury management life-cycle.

• Triage injury/illness calls to determine if emergent/non-emergent
• Determine if injury/illness requires immediate treatment or first aid advice
• Research/locate the nearest facility to utilize for injury
• Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness;
  Coordination of visit via phone/fax.
• Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability.
• Inform client/injured worker of name/location and contact information of medical facility available.
• Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation.
• Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured worker’s employer and adjuster.
• Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Worker’s Compensation insurance adjuster.
• Log injury/illness details on spreadsheet;
  Client specific
• Enter injured worker, adjuster name and claim number into Billing Portal to apply billing time and status of case as it occurs
• Bill time for each case according to services rendered.
• Field Case Management services for client/injured worker needing onsite Case Management services at the time of visit. This includes communicating directly with the provider and obtaining pertinent paperwork at the visit.
• Generating letters to providers, for clarification of work-relatedness and or treatment plan.
• Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated.
• Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case.
• Coordinate SMO’s with specialists as needed.
• Coordinate FCE’s to determine job capabilities.
• Rotate Call to ensure 24/7/365 CM services; perform duties as stated above for calls received.
• Transfer phone lines every morning and evening for phone coverage 24 hrs a day
• Assist Upper Management in CM activities as requested.
• Answer phones in a professional manner when receptionist is not available.
• Attend and participate in staff meetings.
• Assists in office related tasks as needed.
• Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops.
• Other duties assigned by the supervisors.

• High School Diploma or GED required and completion of a vocational program leading to a nursing license.