PA Field Based Nurse Case Manager Cypress Care
The area of coverage for this position is the Greater Philadelphia area. The position primarily works from home, but does require occasional onsite coverage at the Philadelphia Airport.
Responsible for managing the medical care received by a claimant following an injury. The Medical Case Manager monitors all treatment and acts as a liaison between the account, provider, and the claimant for returning the claimant to health and/or work in an appropriate amount of time based on disability guidelines and physician assessment) and is responsible to coordinate care with quality and cost effective outcomes.
Essential Duties & Responsibilities
Implements and acknowledges all new referral contacts to account, claimant and physician within same business day.
Monitors all treatment and acts as a liaison between the account, provider, and the claimant.
Arranges and attends all medical evaluations, physician appointments and physical therapy when needed, including those that may occur before and after regular business hours, or on occasional weekends and holidays in the event of catastrophic cases.
Cases are assigned with geographic location taken into consideration, but territory may extend beyond a given location and cross state lines in some instances, depending upon need.
Participates in coverage as needed for other team members and co-workers as able/requested by supervisor.
Coordinates Independent Medical Examinations, as well as provider appointments.
Participates in coordination of services for catastrophic cases to include, but not limited to, immediate visitation at Hospital to secure all accident and treatment information, coordination of discharge and home care needs.
Arranges transportation services when necessary and authorized.
Reviews and evaluates all medical correspondence obtained from providers.
Coordinates and monitors home health care as necessary.
Implements and utilizes community resources when applicable.
Coordinates case management reviews with the Case Management Supervisor on all files.
Provides medical testimony as required.
Holds to the philosophy and standards of quality as outlined by Procura Management Inc.
Contacts accounts for directives and provides updates on file status. Completes written correspondence completed after each visit or every 30 days according to account profile.
Inputs service notes on all tasks utilizing the RMS system.
Prepares all letters and reports and emails to office for formatting and mailing.
Updates accounts via emails and phone.
Secures ongoing medical records and handles as confidential information.
Completes job descriptions; observes job site and completes job analyses.
Compares and coordinates medical costs; analyses benefit outcomes and documents savings.
Ensures confidentiality and maintains accurate record keeping.
Maintains all educational requirements to renew and maintain licensure and certification.
Maintains professional education in the area of rehabilitation and case management as well as current medical trends.
Coordinates and attends all scheduled team meetings with all providers when necessary.
Utilizes effective oral, written and organization skills and demonstrates the ability to prioritize case activities.
Utilizes personal vehicle to travel to job sites, claimant homes, attorney offices and medical facilities as necessary to perform visits.
Performs other case management duties as required.
Coordinates specialty services as authorized and needed by the account.
Maintains the highest level of customer/client confidentiality and customer service.
This position has no supervisory responsibilities.
Accountability: Exhibit and drive a sense of urgency, responsiveness and credibility.
Adaptability: Ability to work effectively in a fast paced environment while consistently producing error-free work and meeting deadlines.
Communication: Speak clearly, listen actively and convey information effectively both verbally and in writing.
Customer Service: Respond promptly to customer inquiries, build relationship of trust and respect, and strive to meet and/or exceed expectations.
Organization: Demonstrate effective time management, prioritization and organizational skills.
Professionalism: Demonstrate positive and effective interpersonal and relationship management skills internally and externally
Team Work: Contribute to building positive team environment, gives and receives feedback,
and listen to others? views.
This position requires:
(a) A current, unrestricted RN license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; or
(b) In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well being of the persons being served, that requires: (Mandatory)
(i) A degree from an institution that is fully accredited by a nationally recognized
educational accreditation organization; (No Weight)
(ii) The individual must have completed a supervised field experience, in case
management, health, or behavioral health as part of the degree requirements; and
(iii) URAC-recognized certification in case management within four (4) years of hire as a case manager;
Must be able to travel and have a valid driver?s license, reliable transportation and current motor vehicle insurance coverage.
Two years full-time equivalent providing direct clinical care to the consumer.
Excellent communication, interpersonal and organizational skills.
Understanding of managed care, insurance terminology, disability, and workers compensation laws.
Proficient computer skills including typing and Microsoft Office software.
Working from a Procura Management Inc. physical location or home office and frequent travel to and from appointments for field based case management.
||Philadelphia, PA |