RN Case Manager Fresno, CA

Overview

The On-site Workers Compensation Case Manager assesses the medical components of injured workers. Situation including, but not limited to, prior authorization, determination of appropriate level of care, utilization of services, concurrent review, retrospective review, development of discharge plans, assurance of quality and cost effectiveness.

Acts as a liaison among patient / family, employer, insurance company, and health-care personnel to ensure necessary care is provided promptly and effectively to restore injured workers function, capacity and self-esteem.

Responsibilities

Assesses and analyzes injured workers medical status and develops a viable, realistic service plan.

May meet with clients in their homes, work-site or physician’s office to provide ongoing case management services.

Develops a plan of care for patients from admission to discharge.

Monitors patient progress toward desired outcomes through assessments and evaluations.

Communicates both in-person and telephonically with client, medical providers, attorneys, employers, insurance carriers, etc.

Develops and administers education and prevention programs.

Develops guidelines for working with patients, health-care management companies, insurance companies or other third party payers to determine quality, cost-effective care.

Applies all special instructions required by individual insurance carriers and referral sources.

Applies all laws and regulations that apply to the provision of rehabilitation services.

Testifies when called upon to do so, to substantiate any casework or reports that may be seen as relevant to hearing involving client.

Evaluates outcome of patient care.

Prepares reports and other required paperwork as documentation of all casework activities.

May arrange referrals, consultations, therapeutic services, and confers with other specialists on course of care and treatment.

Attends staff meetings.

May participate in sales activities.

Performs other duties as assigned

OHC preferred (Occupational Health Nurse Certification)

Qualifications

EDUCATION / CREDENTIALS :

Licensed RN in accordance with state laws of jurisdiction

Obtaining and maintaining CCM, CDMS or CRRN designations are encouraged; these designations are required where dictated by state regulations.

CCM Certification (Certified Case Management) Required

JOB-RELEVANT EXPERIENCE :

12 months workers compensation case management and / or occupational health nurse experience.