RN Case Manager - Complex Workers' Comp - Los Angeles (Must live in L.A.) - Hybrid

SCM Associates, Inc.; Los Angeles (CA); On-site; USD 65,000 - 95,000; Full time

Job summary

SCM Associates, Inc. is seeking a qualified Case Manager to perform comprehensive patient assessments, develop interdisciplinary care plans, and coordinate services to meet medical and psychosocial needs.

The role requires RN licensure in applicable states, strong communication, and ability to travel to patient appointments. Responsibilities include obtaining authorizations, monitoring care, and reporting outcomes across clinical and financial domains.

Qualifications

• BSN preferred and CCM or equivalent certification.
• Three years or more of related experience and/or training.
• Ability to read, analyze, and interpret medical information.
• Ability to present information clearly to customers, managers, and clients.
• Knowledge of database software, internet software, and MS Word.

Responsibilities

• Processes the case utilizing client's outcome management model and tools.
• Obtains written authorization for case management services as well as release of information.
• Assesses the client/family to identify strengths, resources, problems, and needs.
• Develops a plan of care with interdisciplinary collaboration.
• Identifies, secures, and coordinates services to implement the plan.
• Monitors and reports on services for continued appropriateness.
• Evaluates progress and modifies services as necessary.
• Provides ongoing instruction to client and family on injury/dis-ease process and options.
• Promotes self-advocacy to achieve maximum self-sufficiency.
• Knowledge of benefit packages and funding sources; coordinates with payer for payment.
• Reports outcomes across clinical, functional, financial, and customer satisfaction areas.
• Demonstrates effective verbal and written communication.
• Identifies situations with potential legal liability or poor quality care.
• Frequent travel to patient appointments.
• Performs other related duties as assigned.

Education

BSN preferred

CCM or equivalent certification

Three years or more of related experience

Tools

Database software

Microsoft Word

Job description

Responsibilities and Duties

Responsibilities include the following:

• Processes the case utilizing client's outcome management model and tools
• Obtains written authorization for case management services as well as release of information
• Assesses the client/family to identify their strengths and resources; problems; psychosocial, financial, and medical history; current status; diagnosis; prognosis; functional status; goals; current treatment plan; and needs
• Develops a plan of care with client'’s model through interdisciplinary collab-oration, which identifies realistic short- and long-term goals
• Identifies, secures, and coordinates the services and resources to implement the plan
• Monitors services being provided for continued appropriateness and reports to client and carrier
• Evaluates the client's progress, the plan, and the appropriateness of the services provided, with modifications as necessary
• Provides ongoing instruction to the client and family regarding the injury/dis-ease process, treatment options, and present care
• Promotes the client's/family's self-advocacy skills to achieve maximum self-suf-ficiency
• Has knowledge of the benefit package as well as all available funding sources and systems of care and coordinates with the payer for authorization of payment
• Provides for in-depth reporting of outcomes encompassing clinical, functional, financial, and customer satisfaction areas
• Demonstrates effective, accurate, and timely verbal and written communication in all work situations
• Identifies and discloses all situations which might result in exposure to legal liability and/or are indicative of poor quality care negatively affecting the client
• Frequently requires travel to patient appointments.
• Performs other related duties as assigned in accordance with the necessary job function

Supervisory Responsibilities

This position has no supervisory responsibilities.

People Contact

This position requires regular contact both within the company and outside the company

in order to carry out company policies and procedures. Requires abilities of persuasion

and cooperation. Often deals with persons of equal or higher rank.

Decision Making

This position requires frequent decision making and the ability to plan and perform unusual

or difficult work with general operation methods/procedures.

Supervision Received

This position exercises considerable latitude in determining objectives and approach to

assignments. Completed work is reviewed from a long-term perspective for desired results.

Minimum Position Qualifications

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.

Education and/or Experience:

• BSN preferred
• CCM or equivalent certification
• Three years or more of related experience and/or training or equivalent combination of education and experience

Language Skills:

• Ability to read, analyze, and interpret medical information, professional journals, technical procedures, governmental regulations, and standards of care
• Ability to effectively present information and respond to questions from customers, managers, and clients as appropriate

Mathematical Skills:

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs

Reasoning Ability:

• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form

Computer Skills:

• Knowledge of database software, internet software, and Microsoft word processing software

Certificates, Licenses, Registrations:

• RN license in state(s) where cases are to be managed
• Valid driver's license
• Valid automobile liability insurance

Other Skills and Abilities:

• Ability to organize and evaluate workload and prioritize projects
• Ability to meet deadlines
• Ability to complete multiple, simultaneous projects with accuracy and efficiency
• Detail orientation
• Contract-level acceptance by Paradigm of the Case Manager to manage their cases

Physical Demands

The physical demands described are representative of those that must be met by an employee

to successfully perform the essential functions of this job. Reasonable accommodation

may be made to enable individuals with disabilities to perform the essential

functions.

While performing the duties of this job, the employee regularly is required to sit and

talk or hear. The employee frequently is required to stand and walk. The employee frequently

is required to use hands to finger, handle, or feel and to reach with hands and

arms. The employee occasionally is required to stoop, kneel, or crouch. The employee

occasionally must lift and/or move up to ten pounds. Specific vision abilities required

by this job include close vision (clear vision at 20 inches or less), distance vision, peripheral

vision, and ability to adjust focus.

The work environment characteristics described here are representative of those an

employee encounters while performing the essential functions of this job. Reasonable

accommodation may be made to enable individuals with disabilities to perform the essential

functions. The noise level in the work environment is usually moderate.

At Will Employment

Employment at SCM Associates, Inc. is based on mutual consent, and both the employee

and SCM have the right to terminate employment at will, with or without cause, with or