Egg Harbor, United States
over 1 year ago
Workers Compensation Nurse Case Manager will work within the Workers Compensation guidelines. Will ensure the provisions and continuity of medical services in a timely manner within the appropriate setting for identified injured workers. Works in conjunction with the Medical Director, Director of Clinical Services and Physician advisors.
KEY RESPONSIBILITIES: (Duties may include, but not limited to all or some of the following)
Maintain a thorough knowledge and understanding of medical case management practices and HIPPA guidelines in the health care industry.
Responsible for ensure appropriate medical services and continuity of care for injured workers.
Establish and maintain communications with attending physicians, claims adjusters, injured workers and employer.
Coordinate medical needs and schedule appointments for appropriate assessment and follow-up until maximum medical improvement (MMI) is achieved.
Update adjuster, client and injured worker in timely and professional manner.
Schedule and precertify all necessary medical appointments with providers and ancillary services.
Communicate work status with injured worker, employer and claims adjuster.
Transcribe, document and maintain employee medical history in the WC system using approved format.
Attend Team Meetings and Case Management meeting as scheduled. Review requests for specialty services and direct IN Network when available (define service to be provided; research network providers; direct patients accordingly)
Communicate network negotiation/recruitment needs to Provider Services, Bill Processing and MCCI departments. Attend Field Case Management visits when necessary
Monitor and track Disability Management and Plans on all cases.
Maintain and update Case Review diary/note on all cases.
Monitor Time Management when it applies to a client.
Responsibilities may vary dependent upon specific client requirements.