RN, telephonic Clinical Case Manager

• Determine the appropriate case management track for each assigned case.
• Conduct telephonic clinical assessments covering activities of daily living, psycho-social factors, recent hospitalizations, current clinical status, treatment plans and medications, treating physicians, special needs, and the appropriate outreach interval for each case.
• Develop customized, member-specific clinical case management plans.
• Perform ongoing periodic telephonic outreach at intervals set during the initial clinical assessment.
• Request and track receipt of the records and documentation needed to identify ongoing case management needs.
• Build and maintain a case management resource library to provide members with information relevant to their conditions.
• Assess whether a review is needed for a member's return to their own occupation, and identify the appropriate physician specialty when it is.
• Collaborate with vocational specialists during the case management process when needed.
• Conduct thorough, ongoing quality review of all case documentation and ensure completeness and accuracy of case paperwork.
• Communicate with members, physicians, employers, and clients as appropriate.
• Enter case activities into the case management system accurately and within client-required timeframes.
• Maintain compliance with applicable practice standards and guidelines, including strict confidentiality and HIPAA adherence.

What You'll Bring

• Unrestricted RN licensure, without sanctions.
• Current certification in case management or a related field, or the ability to qualify for certification testing within six months of hire.
• Minimum of five years of clinical experience.
• Minimum of five years of case management experience in one or more of the following: medical, workers' compensation, auto, or disability case management.
• Working knowledge of diagnostic coding (ICD-10).
• Strong critical thinking, decision-making, and organizational skills with close attention to detail.
• Ability to meet deadlines and turnaround times consistently.
• Ability to work independently as well as within a team.
• Computer literacy, including solid working knowledge of Microsoft Word and Excel.
• Strong written, verbal, and telephonic communication skills, with the ability to manage multiple priorities.
• Bachelor's degree in nursing or a health-related field.
• Working knowledge of the insurance industry, medical claims, and/or disability claims.
• Experience with Lean production management.

Work Environment You will be working in an approved remote environment within the states of: Michigan, Illinois, Florida, Texas, or Minnesota. Stressful conditions may arise when the workload becomes more demanding than usual.