Telephonic Nurse Case Manager Job in Brentwood 37027, Tennessee US
What We Do:
MCMC's success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping MCMC grow each year.
Because of our tremendous growth, we are always in search of outstanding individuals.
Summary:
To oversee managed care process and to ensure that managed care activities are performed in accordance with state-mandated regulations and/or client guidelines. To provide telephonic medical management for active claims by assessing, planning, facilitating and advocating the health needs of an injured worker.
Responsibilities:
- Assessment of the individual's personal and medical history, current status, prognosis, current treatment plans and care provider's level of expertise.
- Determines appropriateness of care, quality of care, and timeliness of testing.
- Identifies significant case activity to be reported to the client.
- Identifies case management issues for initiation of Case Management process.
- Identifies and refers cases to the MCMC Review Physicians for review and peer contact with the treating provider, consistent with company and client guidelines.
- Recognizes and addresses medical and non-medical issues which may adversely impact employee recovery and case resolution.
- Identifies appropriate intervention, and alternate, cost effective treatment modalities in order to promote recovery and timely return to work.
- Communicates with the treating provider regarding indications for potential treatment and diagnostic studies.
- Supports and assists injured workers and their families to navigate through the complex array of health, rehabilitation, vocational training, mental health and substance abuse services and programs.
- Serves as a liaison with the claims administration staff and treating provider staff to facilitate maximum benefit and promote recovery.
- Ongoing promotion and maintenance of quality assurance standards from a Case Review/Case Management standpoint, as well as in the provision of customer service.
- Works with Onsite Case Managers, as needed, to facilitate employee's maximal recovery, return to work, and timely case disposition and resolution.
- Works with MCMC Review Physician on issues requiring contact with the Treatment Provider to facilitate quality, timely, cost effective treatment and promote return to work.
- Intervenes promptly on significant cases with high dollar potential to coordinate care and appropriate referrals for the promotion of optimal treatment.
- Identifies any temporary or permanent alterations in function that have resulted from the current injury
- Identifies potential challenges or complications in physiological and/or psychosocial function.
- Ensures that all documentation is current, timely, grammatically correct, consistent and appropriately reflects the sense of circumstances of the case. Documentation must also adhere to company practices.
- Participates in ongoing training meetings and inservices.
- Acts as a member of a team and provides coverage on temporary or permanent basis to other accounts as assigned.
- Other duties as assigned.
Qualifications:
- Ability to work independently, as well as cooperatively with others.
- Experience dealing with multiple tasks, and problem solving under pressure.
- Exposure to and familiarity with computer systems desired.
- Exposure to and familiarity with state regulations governing work related injury claims administration, and with third party reimbursement, when applicable.
- Strong interpersonal skills, including oral and written communications.
- Maintenance of continuing education appropriate to case management, Workers' Compensation issues
- Demonstrated accountability and skills in analysis, decision making and time management
- Bilingual in English/Spanish is desired, but not required
Experience/Education
- Registered Nurse, Tennessee State Licensure. (CCM) Certified Case Manager preferred.
- Minimum 3-5 years of acute clinical experience preferred.
- Minimum 1 year of Telephonic Nurse Case Management.
- Must have strong background, consisting of three or more year's experience in Workers' Compensation injury management, from an Occupational Health, Utilization Review or Rehabilitation preferred.
Please send resumes to:
MCMC LLC
Attn: Human Resources
300 Crown Colony Drive, Suite 203
Quincy, MA 02169
Fax: 877-879-3097
E-mail: MA.HR@mcmcllc.com
An Equal Opportunity Employer
January 9, 2012
• Tags: Telephonic Nurse Case Manager Job in Brentwood 37027, Tennessee Us • Posted in: General