Field​/Remote Nurse Case Manager RN

Job Description

Eagle One Case Management Solutions, Inc

RN Case Manager

Summary

Provides nursing, clinical, casework services by performing the following duties:

• Effectively manages a caseload of 22‑25 active field case management files if full field, 45‑55 telephonic case management files, or 35‑45 if mixed TCM/FCM depending on complexity. Part‑time employees handle case load of 12‑18 files dependent on acuity and determined by supervisor and medical manager.
• All full‑time medical case managers are required to bill a minimum of 40 hours per week. Part‑time to be discussed and decided upon by supervisor.
• Maintains the Outlook calendar by keeping all meetings and/or appointments current, documenting changes as they occur, throughout the week, for weekly review.
• Tasks must be kept current and updated on a daily basis.
• Attends and participates in all mandatory meetings, training or corporate events, in person or through electronic means, as required.
• Initial four‑point contacts must be made within 24‑48 hours from the date of the referral and the initial email sent immediately thereafter.
• Timely closure of files with internal charting complete and up to date, including impact points.
• Understands and demonstrates ability to apply Eagle One case management protocols.
• Consults with Manager and internally round tables on complex cases, claim barriers and resolution planning.
• Demonstrates ability to effectively create medical timelines.
• Prepares case summaries for account claim reviews.
• Responsible for maintaining a complete medical file kept in chronological order, no duplication, in a paperless format.
• Alerts Manager of any requests to deviate from Eagle One or account‑specific protocols and obtains approval to proceed as necessary.
• Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.).
• Responsible for initial and ongoing analysis of the diagnosis as it relates to the work injury and the medical treatment rendered.
• Provides expert consultation for interpretation of medical information and how it impacts the case.
• Projects anticipated dates for modified and full‑duty work releases utilizing disability/medical criteria and documents any deviations at each appointment.
• Continually addresses physical job demands and availability at physician appointments to encourage appropriate work release.
• Contacts medical providers within 24 hours of appointments to obtain disability and medical status.
• Determines and documents appropriateness of medical treatment and whether it meets disability/medical criteria throughout claim duration.
• Updates employer and any other appropriate parties with any change in disability or medical status and appointment information within 24 hours of appointment date and coordinates return to work per protocol.
• Adheres to jurisdictional rules and regulations and applies to each case as appropriate.
• Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within an average 2‑hour radius from home office.
• Meets or exceeds Eagle One guidelines for return‑to‑work outcomes and medical closure durations.
• Involved in Public Health community wellness fairs and clinics as needed.
• Attends appointments as needed for PRN case managers per field guidelines.

To perform this job successfully, an individual must be detail‑oriented with exceptional communication and interpersonal skills. Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Active RN licensure in state of employment.
• Bachelor’s Degree preferred.
• Additional certifications a plus (e.g., CCM, CDMS, CLNC).

Reasoning Ability – Ability to define problems, collect data, establish facts, and draw valid conclusions.

Knowledge of Microsoft Windows/Office (Word, Excel, Outlook). Ability to navigate the internet for research and has general working…