At a Glance
- Tasks: Manage medical claims and coordinate care for injured employees via phone.
- Company: Join Davies North America, a leader in innovative insurance solutions and professional services.
- Benefits: Enjoy remote work, competitive salary, health plans, 401k matching, and generous time-off policies.
- Why this job: Make a real impact on people's recovery while working in a supportive and diverse environment.
- Qualifications: Must be an RN with at least three years of clinical experience and one year in Florida Workers’ Compensation.
- Other info: Bilingual candidates (English/Spanish) are encouraged to apply.
The predicted salary is between 60000 - 65000 £ per year.
Telephonic Nurse Case Manager
Department: Claims Administration & Adjusting
Employment Type: Permanent – Full Time
Location: Home United States
Reporting To: Shaunna Jones
Compensation: $78,000 – $83,000 / year
Description
Responsible for the management and independent decision making on medical claims. Monitors, analyzes, evaluates and coordinates the delivery of high quality, timely, cost effective medical treatment and other health services as needed by an injured employee to promote an appropriate, prompt return to work when medically indicated. Manages all care throughout the continuum of services in order to achieve the highest level of quality medical care in the most cost effective and timely manner possible. Performs ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury. Performs Telephonic Case-Management activity on Workers’ Compensation cases according to parameters identified/required performance standards per the State of Florida.
Key Responsibilities
- Provide telephonic case-management in a Workers’ Compensation environment. Focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved, along with increase in productivity.
- Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and when authorized, any qualified rehabilitation consultant, to achieve the goals
- Clinically evaluate the recovery needs of an injured employee after the initial contact assessment. Incorporate into the initial plan information obtained from the employer and provider.
- Identify barriers to recovery and formulates an action plan to overcome these barriers.
- Provide ongoing assessment of health and medical records.
- Monitor and audit health provider ensuring licensure and appropriate care.
- Monitor vendor performance, ensuring quality service.
- Develop case management care plan, tracks and modifies appropriately
- Appropriately document all data received from interviews, contacts and medical records in the computerized system.
- Address the return-to-work capability with the injured worker and provider at each medical evaluation. Document appropriately in computerized system. Obtain a job description from the employer and presents to the provider if necessary. Verify disability against approved guidelines, questioning variances.
- Manage the file adhering to treatment guidelines and utilization criteria as determined by the state-mandated guidelines, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to injured workers or third party claimants.
- Create, edit and/or revise correspondence.
- Evaluate treatment plans and documents outcomes. Track protocol management for appropriate utilization and delivery of medical services. Outcomes will be evidenced by patient satisfaction, appropriate delivery and quality of care and timely recovery per evidenced based criteria and clinical guidelines. Return-to-work outcomes and length of disability outcomes are calculated and monitored according to criteria as published in the Official Disability Guidelines.
- Manage the file pro-actively, utilizing all appropriate case management tools.
- Develop alternative treatment plans when necessary. Demonstrate the ability to accommodate changes on the case-management process for delivery of a more refined and efficient system.
- Identify the need for utilization review procedures to claims, such as triggers that might indicate a potential barrier to recovery. UR tools include physician advisor review, pre-certification, pre-authorization, concurrent review and retrospective review of bills and reports. Communicate the findings determined in utilizing these tools and document appropriately.
- Anticipate health needs during case-management process and educate patient and family appropriately. Encourages the injured worker to participate in the recovery plan.
- Review medical bills for appropriateness and forward bills to Bill Review/Cost Containment Organization for adjudication.
- Maintain patient privacy by ensuring that all medical records, case specific information and provider specific information are kept in a confidential manner, in accordance with state and federal laws and regulations.
- Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards.
- Serve on appropriate committees such as Grievance, Quality Assurance and others as directed.
- May negotiate fees with providers or channel cases to other vendors as appropriate.
- Maintains contracted State of Florida performance standards for case management.
- May train claims staff on the identification of medical case management opportunities.
- May provide leadership of lower graded staff in the department.
- Perform other duties as needed.
Skills, knowledge & expertise
- Case-management experience mandatory – 1 year Florida Workers’ Compensation.
- Maintains knowledge of current trends, standards and law changes.
- Must be self directed and able to work independently.
- Ability to effectively operate a personal computer and related claims and business software.
- Good communication skills, both oral and written. Team player. Good attendance. Good customer service skills.
- RN with a minimum of three years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational).
- At least one year’s experience handling Florida Workers’ Compensation case management (contractual requirement).
- Proof of current State Licensure.
- Bilingual – fluent English/Spanish helpful.
Benefits
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
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Telephonic Nurse Case Manager employer: Davies
Contact Detail:
Davies Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Telephonic Nurse Case Manager
✨Tip Number 1
Familiarise yourself with Florida Workers' Compensation laws and regulations. Understanding the legal framework will not only help you in interviews but also demonstrate your commitment to the role.
✨Tip Number 2
Network with professionals in the case management field, especially those who work in Workers' Compensation. Attend relevant webinars or local meetups to build connections that could lead to job referrals.
✨Tip Number 3
Brush up on your telephonic communication skills. Since this role involves a lot of phone interaction, practice clear and concise communication to ensure you can effectively manage cases over the phone.
✨Tip Number 4
Research Davies North America and their approach to case management. Tailoring your discussions during interviews to reflect their values and mission can set you apart from other candidates.
We think you need these skills to ace Telephonic Nurse Case Manager
Some tips for your application 🫡
Tailor Your CV: Make sure to customise your CV to highlight relevant experience in case management, particularly within the Florida Workers’ Compensation system. Emphasise your clinical experience and any specific skills that align with the job description.
Craft a Compelling Cover Letter: Write a cover letter that showcases your passion for telephonic case management and your understanding of the role. Mention how your previous experiences have prepared you for the responsibilities outlined in the job description.
Highlight Key Skills: In your application, focus on key skills such as communication, independent decision-making, and the ability to manage medical claims effectively. Use specific examples from your past work to demonstrate these skills.
Proofread Your Application: Before submitting, carefully proofread your application materials for any spelling or grammatical errors. A polished application reflects your attention to detail and professionalism, which are crucial in this role.
How to prepare for a job interview at Davies
✨Understand the Role
Make sure you thoroughly understand the responsibilities of a Telephonic Nurse Case Manager. Familiarise yourself with the key tasks such as managing medical claims, coordinating care, and facilitating communication among various stakeholders.
✨Showcase Your Experience
Be prepared to discuss your previous case management experience, especially in Florida Workers’ Compensation. Highlight specific examples where you successfully managed cases, overcame barriers to recovery, and ensured quality care.
✨Demonstrate Communication Skills
Since this role involves significant communication with injured workers, employers, and healthcare providers, practice articulating your thoughts clearly. Be ready to provide examples of how you've effectively communicated in challenging situations.
✨Prepare Questions
Have a list of insightful questions ready to ask the interviewer. This could include inquiries about the team dynamics, the tools used for case management, or how success is measured in the role. It shows your genuine interest in the position.