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Nurse - Case Manager in Los Angeles, CA at QuestPro Consultants

Date Posted: 1/18/2019

Job Snapshot

Job Description

Telephonic Nurse Case Manager (RN) -Workers Compensation

*Must be willing to work onsite 2-3 days a work in either Chatsworth or Palmdale, CA locations: 

Responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Works as an intermediary between carriers, attorneys, medical care providers, employers and employees to ensure appropriate and cost-effective healthcare services and a medically rehabilitated individual who is ready to return to an optimal level of work and functioning. The onsite nurse will have individual job responsibilities per client needs.

Main responsibilities include but are not limited to:

  • Follows the Specific Client Process for Case Management. 
  • Using clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality of care and cost containment. 
  • Initializing review and assessment of case information and referral objectives.
  • Verifying employee’s job Title/Description.  
  • Perform three-point contact to include the following:
    • Contact Employee to 1)Disclosure of Case Manager’s role and responsibilities; 2) Express your and the employer’s concern for the employee’s health; 3) Educate the employee in company policies and regulations; 4)Support employee in complying with prescribed treatment plan; 5) Assess employee motivation and resources (personal and interpersonal) that support return to work; 6)Establish and maintain Case Management goals and expectation of return to work in a safe and timely manner with the employee.
    • Contact Provider to 1)Identify yourself and explain your role; 2) Ascertain treatment plan in order to assist patient compliance; 3) Request reports if appropriate; 4) Determine return to clinic date, referrals and projected return-to-work date.
    • Contact Employer/Adjuster/Insurer to 1) Provide diagnosis, therapy, providers and projected return-to-work date; 2) Provide hard copy follow-up within 72 hours of original contact date; 3) Review with employer the employee and provider’s concerns.
  • Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.      
  • Maintaining daily records of all contacts.
  • Serving as an intermediary to interpret and educate the individual on his/her disability,  and the treatment plan established by the case manager, physicians, and therapists.   Explains physician’s and therapists’ instructions, and answers any other questions the  claimant may have in an effort to facilitate his/her return to work. 
  • Working with the physicians and therapists to set up medical assessments to develop an overall treatment plan that ensures cost containment while meeting state and other regulator’s guidelines.
  • Researching alternative treatment programs such as pain clinics, home health care, and work hardening.  Coordinating all aspects of the individual’s enrollment into the programs, and then monitors his/her progress, in an effort to maximize cost containment and minimize time away from work. 
  • Working with employers on modifications to job duties based on medical limitations and the employees functional assessment.  Helps employer rewrite a job description, when necessary and possible, in an effort to return the client to the workplace.
  • Monitoring/evaluating the employee’s progress.
  • Supplying employer/adjuster/insurer with periodic reports agreed to in original contract, but not less than biweekly.
  • Providing input on the performance of support staff to their supervisor.
  • Tracking client updates by use of daily open listing.
  • Attending scheduled staff meetings and in-service programs.
  • Other duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. 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

  • Diploma, Associates Degree or Bachelor’s Degree in Nursing required.  Advanced Degree preferred.
  • Minimum of two (2) years full time equivalent of direct clinical care to consumers/ clinical practice.
  • Workers’ compensation-related experience preferred.
  • A current, unrestricted 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
    • 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:
      • A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization;
      • The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and
      • URAC-recognized certification in case management within four (4) years of hire as a case manager 
  • Pursue URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN) upon eligibility.  Other state licenses/certifications as required by law.
  • Prior Case Management experience preferred.
  • Excellent interpersonal skills and phone manners and excellent organizational skills. 
  • Ability to set priorities, to work independently and as part of a team. 
  • Computer literacy required. 
Skills: Telephonic Case Manager, Nurse, RN, Workers compensation Benefits: Healthcare Certifications: RN - Registered Nurse Bonus: yes Reason Open: growth