Nurse Case Manager

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Full Time St. charles, IL, US

Salary Range: $87,000.00 To $ Annually

Join Insurance Program Managers Group (IPMG) and become part of a dynamic team committed to innovation in insurance! For the past 25 years, our mission has been to create one-of-a-kind insurance solutions for our partners. We bring proactive and tailored approaches to our clients, valuing the unique contribution of each team member. Together, we shape our identity and drive transformative change for our clients.

While this is a remote role, candidates must be located in one of the following states: AL, AZ, CA, CT, FL, GA, IL, IN, KY, MA, MI, NY, NC, NH, OH, PA, SC, SD, TN, TX, VA, WI

We are looking for a fully remote Registered Nurse for our Nurse Case Manager position. Candidate will need 1+ years of case management experience in which there is a return to work focus and two years full-time equivalent of direct clinical care to the consumer. This position will be a part of a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health and/or disability needs through communication and available resources to promote quality cost-effective outcomes.

The position will primarily support short term disability and workers’ compensation with potential for group health benefits case management.

• Conducts initial and ongoing assessments to identify patient status and individual needs; promotes client self-determination
• Assists in identifying appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.
• Utilizes appropriate resources and case management interventions to facilitate the case management plan and to allow for the individual’s optimum level of wellness and functional capability with quality cost-effective outcomes appropriate to health plan and workers’ compensation
• Develops a specific case management plan in collaboration with the consumer and members of the health care team with periodic updates. Identifies short term goals, long term goals, interventions to meet goals, resources to be utilized, time frames for re-evaluations, and collaborative approaches to facilitate the case management plan
• Executes and documents specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan
• Gathers sufficient information from all relevant sources and its documentation regarding the case management plan and it activities and/or services to enable the determination of the plan’s effectiveness
• Evaluates at appropriate intervals, determining and documenting the case management plan’s effectiveness in reaching desired outcomes and goals with modifications, as appropriate
• Measures and modifies the interventions to determine the outcomes of the case management involvement
• Implements care plan by facilitating authorizations and referrals, as appropriate, within benefit structure, contractual agreements or jurisdictional regulations; utilizing nationally accepted evidence based criteria as guidelines for treatment protocols
• Documents all contacts according to Best Practices, utilizing templates, as required
• Notifies claims personnel regarding anticipated surgeries, benefit exceptions, and other significant events that may require special handling
• Manages the disability durations proactively,…