Medical Case Manager - Remote / Telecommute

Cynet Systems Inc; Bethesda (MD); Remote; Full time

Job summary

A leading company in Bethesda is seeking a skilled Registered Nurse for medical case management. The role involves coordinating treatment plans, managing disability durations, and collaborating with various stakeholders to ensure effective case management. Candidates should have excellent communication skills and a strong background in nursing, along with relevant certifications. This is a great opportunity for those looking to make a significant impact in the healthcare field.

Qualifications

• 3+ years of clinical experience as a Registered Nurse.
• 2+ years experience in medical case management.
• National certification in case management preferred.

Responsibilities

• Coordinate treatment pathways for claims.
• Manage disability duration and return-to-work opportunities.
• Document case management plans and assessments.

Skills

Communication

Organizational Skills

Analytical Skills

Customer Service

Education

Bachelors in Science Nursing

Associate in Nursing (ASN)

Nursing Diploma

Tools

Microsoft Office

Job description

Job Description:

Pay Range: $33.50hr - $38.50hr

Responsibilities:

• Responsible for coordinating the treatment pathways of those claims that meet the internal case management criteria, including setting the appropriate treatment plan and other activities that meet an injured worker's/employee's health and return-to-work needs or other productive activity.
• Understands and implements criteria for identifying individuals for case management services.
• Coordinates case management plans and activities with the human resources department of the injured worker/employee, as appropriate.
• Solicits the employee's interest and consent, if necessary, for participation in case management activities and documents oral and/or written consent.
• Documents a case management plan specific to the injured worker/employee that includes short and long term goals with timeframes, timeframes for re-evaluation, resources to be utilized, and collaborative approaches to be used (including physician participation).
• Conducts and documents an assessment of each injured worker/employee including (as appropriate) health status, treatment plan, financial resources for health care, psychosocial status, consumer knowledge, education needs in relation to health status and treatment plan, past relevant history, and possible non-medical impediments to successful resolution.
• Responsible for managing the disability duration of an injured worker/employee and focus on return to work opportunities or other productive activity, including working with medical providers to identify an estimated return to modified duty, vocational rehabilitation, release from care, or actual return-to-work date.
• Collaborates and clearly communicates with the injured worker/employee, family members, providers, employer, or the employer's representative in the execution of a plan for return-to-work or other productive activity.
• Identifies and obtains any required or outstanding medical documentation in support of the individual's plan for a return-to-work or other productive activity.
• Understands and implements criteria for discharge of injured worker/employee or termination of case management services.
• Promotes goodwill by assisting all involved parties on issues related to the injured worker/employee, provider relations, and OWCP coordination, as applicable.
• Identifies, evaluates, and recommends strategies for claims where vocational rehabilitation services may produce an eventual return-to-work; interfaces with vocational rehabilitation or other specialties as appropriate and applicable.
• Understands the organization's quality management program and the case manager's role within that program.
• Experience with Federal Employee Compensation Act (FECA) and FECA related issues preferable, as applicable for assigned account(s).
• Is an effective team member; supports the team by pitching in at any level and effectively working across the organization to meet the needs of the business.
• Takes ownership of personal actions and outcomes; encourages and empowers others to do the same.
• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change.
• Ability to work independently, multitask, and adjust priorities.

Education:

• Bachelors in Science Nursing or Associate in Nursing (ASN) or Nursing Diploma.
• 3+ years of clinical experience as a Registered Nurse.
• 2+ years experience in medical case management, discharge planning, utilization review/management to determine the necessity of medical services, occupational health, and/or comparable field.
• Experience in Behavioral Health Chronic Medical Conditions or Oncology preferred.

Certification:

• National certification in case management or related field preferred.

License:

• Unrestricted Current State Registered Nurse License, We need to have a record of RN Licenses for all Medical Case Managers submitted with their new hire paperwork.

Communication Skills:

• Excellent verbal, written, and interpersonal communication skills, organizational and analytical skills.
• Superior customer service skills working proactively and collaboratively with client colleagues and client leaders, medical staff, and co-workers.
• Ability to effectively present information.
• Excellent team player; ability to partner with internal and external clients and other cross-functional departments.
• Superior writing and communication skills.
• Utilizes direct communication and proactive problem solving to address challenges and disagreements.
• Proficiency in Microsoft Office and Computer proficiency.

Coordination and Service Delivery:

• Appreciate and comply with all confidentiality requirements.
• Be proficient in how to obtain and document an accurate medical history.
• Be skilled in developing treatment plans with realistic goals.
• Understand information systems and data management.
• Be capable of assisting individuals with the development of short- and long-term goals for recovery.

Case Management Concepts:

• Be educated in current protocols and procedures for case management related to the WTC-NPN environment.
• Have an understanding and appreciation for nationally recognized standards of the case management process, particularly in regard to long-term medical conditions.
• Community Resources.
• Access and evaluate available resources and develop additional resources as the need arises.
• Maintain relationship with WTC-NPN team, including representatives of claims, call center, and network.