RN, Telephonic Clinical Case Manager

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Identify the suitable case management track for each case assigned.

• Perform telephonic clinical evaluations that encompass daily living activities, psycho-social elements, recent hospital stays, current clinical status, treatment plans and medications, treating physicians, special needs, and the recommended outreach frequency for each case.

• Create tailored, member-specific clinical case management strategies.

• Execute continuous periodic telephonic outreach at intervals established during the initial clinical evaluation.

• Request and monitor the receipt of necessary records and documents to determine ongoing case management requirements.

• Develop and maintain a case management resource library to supply members with pertinent information regarding their conditions.

• Evaluate if a review is necessary for a member's return to their previous occupation and identify the correct physician specialty when required.

• Collaborate with vocational specialists as needed throughout the case management process.

• Conduct comprehensive, ongoing quality reviews of all case documentation, ensuring completeness and accuracy of case paperwork.

• Communicate effectively with members, physicians, employers, and clients as appropriate.

• Accurately enter case activities into the case management system within the timeframes required by clients.

• Adhere to relevant practice standards and guidelines, including strict confidentiality and compliance with HIPAA regulations.

⛳️ Requirements

• Valid RN licensure without any sanctions.

• Current certification in case management or a related field, or the ability to qualify for certification testing within six months of employment.

• At least five years of clinical experience.

• A minimum of five years of experience in case management within one or more of the following areas: medical, workers' compensation, auto, or disability case management.

• Proficient understanding of diagnostic coding (ICD-10).

• Excellent critical thinking, decision-making, and organizational abilities with meticulous attention to detail.

• Consistent ability to meet deadlines and turnaround times.

• Capability to work autonomously as well as collaboratively within a team.

• Computer proficiency, including a strong working knowledge of Microsoft Word and Excel.

• Exceptional written, verbal, and telephonic communication skills, with the ability to manage multiple priorities effectively.

• Bachelor's degree in nursing or a health-related discipline.

• Familiarity with the insurance sector, including medical and/or disability claims.

• Experience in Lean production management.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Retirement plan options with employer contributions.

• Opportunities for professional development and continuing education.

• Flexible working hours and remote work options.

• Generous paid time off and holiday leave.