Eagle One Case Management Solutions, Inc

RN Case Manager

Summary

Provides nursing, clinical, casework services by performing the following duties:

Essential Duties and Job Responsibilities:

• Effectively manages a caseload of 22-25 active field case management files if full field, 45-55 telephonic case management files, or 35-45 if mixed TCM/FCM depending on complexity. Part time employees handle case load of 12-18 files dependent on acuity and determine by supervisor and medical manager.
• All full time medical case managers are required to bill a minimum of 40 hours per week. Part time to be discussed and decided upon by supervisor.
• Maintains the Outlook calendar by keeping all meetings and/or appointments current and documenting changes as they occur, throughout the week, that will be available for weekly review
• Tasks must be kept current and be updated on a daily basis
• Attends and participates in all mandatory meetings, training or corporate events, within person or through electronic means, as required
• Initial four-point contacts must be made within 24-48 hours from the date of the referral and the initial email must be sent immediately thereafter
• Timely closure of files with internal charting complete and up to date, including impact points
• Understands and demonstrates the ability to apply Eagle OneTM case management protocols
• Consults with Manager and internally roundtables on complex cases, claim barriers and on resolution planning.
• Demonstrates the ability to effectively create medical timelines
• Prepares case summaries for account claim reviews
• Responsible for maintaining a complete medical file which is kept in chronological order with no duplication of information in a paperless format
• Alerts Manager of any requests to deviate from Eagle OneTM or account specific protocols and obtains approval to proceed as necessary
• Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.)
• Responsible for initial and ongoing analysis of the diagnosis as it relates to the work injury and the medical treatment rendered
• Provides expert consultation for interpretation of medical information and how it impacts the case
• Projects anticipated dates for modified and full-duty work releases utilizing disability/medical criteria and documenting any deviations at each appointment
• Continually addresses physical job demands and job availability at physician appointments to encourage appropriate work release
• Contacts medical providers within 24 hours of appointments to obtain disability and medical status
• Determines and documents appropriateness of medical treatment and whether or not the treatment meets disability/medical criteria throughout claim duration
• Updates employer and any other appropriate parties with any change in disability or medical status and appointment information within 24 hours of appointment date and coordinates return to work per protocol
• Adheres to jurisdictional rules and regulations and applies to each case as appropriate
• Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within an average 2 hour radius from home office.
• Meets or exceeds Eagle OneTM guidelines for return-to-work outcomes and medical closure durations
• Involved in Public Health community wellness fairs and clinics as needed

• If PRN case manager, perform tasks as requested and attend appointments as needed per field guidelines.

Qualifications

To perform this job successfully, an individual must be detail-oriented with exceptional communication and interpersonal skills. Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

· Active RN licensure in state of employment

· Bachelor’s Degree preferred

· Additional certifications a plus (i.e. CCM, CDMS, CLNC)

Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions.