Senior Nurse Case Manager - Disability & RTW

JOB DESCRIPTION

Essential Duties & Responsibilities
Performs a combination of duties in accordance with departmental guidelines:

• Assesses disability status, makes recommendations and identifies appropriate resources.
• Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability.
• Consults on case management issues in area of specialty and applies effective case management interventions.
• Collaborates with medical and other providers to ensure appropriate treatment and return to work.
• Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused.
• Addresses causality and refers to appropriate medical expertise.
• Documents according to jurisdictional, departmental and accreditation requirements.

Reporting Relationship
Typically Lead Specialty Nurse Case Manager

Skills, Knowledge and Abilities

• Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures.
• Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service.
• Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner.
• Strong interpersonal skills with the ability to effectively interact with internal and external business partners.
• Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks.
• Knowledge of Microsoft Office Suite as well as other business related software.
• Ability to work independently.

Education and Experience

• RN with BSN preferred. Eligible to sit for national case management certifications.
• Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred