Telephonic Nurse Case Manager

Telephonic Nurse Case Manager page is loaded## Telephonic Nurse Case Manager locations:
San Diego, CA:
Pleasanton, CA:
Sacramento, CA:
Woodland Hills, CAtime type:
Full time posted on:
Posted Todayjob requisition :
JR101132

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today.

We strive to make both our  internal and external communities better everyday!
** PURPOSE OF THE JOB
** The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker’s compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risks on behalf of the Company.
** ESSENTIAL DUTIES AND RESPONSIBILITIES
** Creates and manages worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
* Performs initial and ongoing clinical assessment via telephone calls to relevant parties that may include the injured worker, physician, attorney or other parties .
* Assesses client's situation for psychosocial needs, cultural implications and ensures support systems are in place.
* Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
* Monitors ongoing progress toward established goals and objectives.
* Implements plan through case management interventions and communication with all parties to reach desired goals and objectives.

Measures effectiveness of treatment plans and creates alternate strategies when needed.
* Recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
* Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
* Negotiates and coordinates a prompt return to work with employer.
* Measures and reports on interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction.
* Maintains accurate record of management including costs, savings and demographic data.

Communicates effectively with all parties involved in injured worker’s treatment.
* Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
* Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.
* Maintains injured worker's privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards.
* Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
* May perform Utilization Review activities (or review information coming through a vendor partner); presents reports to clients and providers .
** SUPERVISORY RESPONSIBILITIES
** This role does not have supervisory responsibilities.
** EDUCATION AND EXPERIENCE
** Associate's or Bachelor’s degree from four-year college or university in Nursing preferred. Equivalent combination of education and experience may be considered. Minimum 2 years of professional experience providing direct clinical care required. Case Management in WC, Discharge Planning, or Home Health preferred.
** CERTIFICATES, LICENSES, REGISTRATIONS
** Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required. Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.
** KNOWLEDGE AND SKILLS
** Working knowledge in direct clinical care required.  Ability to work…