Telephonic Nurse Case Manager REMOTE EST
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AI Summary
The Telephonic Nurse Case Manager identifies, assesses, and coordinates medical services for individuals to ensure quality and cost-effective outcomes. Responsibilities include managing precertifications, collaborating with healthcare teams, and developing return-to-work strategies.
Charles Taylor is a highly successful global provider of professional services to the insurance industry. We are seeking an experienced Telephonic Nurse Case Manager to join our team. This is a remote role for the EST.
Position Summary
The Telephonic Nurse Case Manager position, using discretion and independent judgment, has the responsibility to identify, assess, plan, coordinate, monitor and evaluate medical services for individuals requiring case management services per client contract. The goal of the case manager is to provide quality, cost effective outcomes for the client through collaboration and communication with the claimant, provider, adjusters and other members of the healthcare team. The right candidate will also provide and coordinate precertification of diagnostic testing, surgical procedures and peer review.
Essential Functions
- Obtain request for services from adjuster and enter appropriate information into claims system.
- Provides precertification as requested by the adjuster or provider.
- Communicates telephonically with patients, medical providers, adjusters, attorneys, and vendors
- Communicates with provider for medical records, evaluates and assesses appropriateness of treatment. Develops a plan for physical/ medical services and return to work strategies through interdisciplinary collaboration, which identifies realistic short and long-term goals.
- Coordinate necessary medical and rehabilitative care for injured employees including but not limited to appointments, medications, surgery, therapies, diagnostics, equipment, transportation, translation etc.
- Provides comprehensive documentation detailing case management services, the injured employees’ progress with treatment plan, return to work status, maximum medical improvement, and significant events that meets company standards for content and format
- Negotiates for the highest quality, most cost-effective appropriate services. Identifies cost savings, as appropriate, on assigned cases.
- Demonstrates effective, accurate and timely verbal and written communication on assigned cases.
- Reviews medical billing, as necessary, on assigned claims.
- Maintain Quality Management standards.
- Maintains a working knowledge of up-to-date medical information including but not limited to medications, procedures, equipment, therapies, treatments, their uses, contraindications, side effects, etc.
Core Competencies
- Strong attention to detail with a high degree of accuracy and thoroughness.
- Sound decision-making and problem-solving abilities.
- Excellent organizational and time management skills, with the ability to prioritize multiple tasks effectively.
- Strong technical aptitude and the ability to quickly learn new systems and processes.
- Commitment to providing exceptional customer and client service.
- Excellent written and verbal communication skills.
- Ability to work effectively both independently and as a collaborative member of a team.
- Adaptable and flexible in a fast-paced, changing work environment.
- Proficient in Microsoft Windows and standard office applications, with strong keyboarding and data entry skills.
Qualification and Education Requirements
- Current RN licensure, multistate license preferred
- Minimum one-year direct patient care
- Degree in nursing
Additional Experience (preferred but not required)
- Prior telephonic/field case management or Utilization management within the workers’ compensation industry
- CCM (Certified Case Manager)
Charles Taylor offers a competitive salary commensurate with experience and excellent benefits including medical, dental, vision, life insurance and 401(K) with match. If you are seeking a career where you can achieve great things for great clients in a supportive and collaborative environment, then we may be the place for you.
Values
At Charles Taylor, our values define our identity, principles and conduct. This person will demonstrate and champion Charles Taylor Values by ensuring Agility, Integrity, Care, Accountability and Collaboration.
AAP/EEO Statement
Here at Charles Taylor, we are proud to be an Inclusive Employer. We provide an environment of mutual respect with zero tolerance to discrimination of any kind regardless of age, disability, gender identity, marital/ family status, race, religion, sex or sexual orientation.
Our external partnerships and the dedicated work we do in promoting a transparent and fair recruitment and selection process all contribute to the successful, inclusive and diverse culture and environment which we are proud to be a part of at Charles Taylor.
About Charles Taylor
Charles Taylor is an independent, global provider of claims solutions, insurance management services and technology platforms for all property and casualty markets, including commercial property, workers’ compensation, and auto/liability. We offer complex loss adjusting, technical services, third-party administration, and managed care programs with specialization in catastrophic, aviation, energy, and marine claims. With over 100 years of expertise at our core, we offer a comprehensive suite of solutions across all lines of business to help our clients manage risk.
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