Nurse Case Manager - Workers' Compensation - Remote

ABOUT THE POSITION POSITION: Workers’ Compensation Medical Case Management Nurse (Nurse Case Manager) REPORTS TO: Director of Medical Management and/or Designees LOCATION: This position may require employees to visit the office, field assignments, presentations, trainings, or other professional events on a schedule or on occasion. This position will be primarily or totally remote. Applicants must be residents of Idaho, Washington, Arizona, New Mexico, or Texas with a valid and unrestricted compact LVN license will be considered for this position. HOURS: Monday through Friday, normal business hours, 8 hours per day. Some overtime may be required. PRINCIPAL ACCOUNTABILITY As a Nurse Case Manager you will deliver quality care, control cost of treatment plans and provide the greatest medical oversight of an injured worker’s progress. Working closely with the claim’s administrator, your goal is to ensure the treatment plans are medically appropriate with the emphasis on early “return to work”. This is accomplished through activities including but not limited to the below. • Anticipate needs and coordinate care to prevent delays and complications. • Monitor progress and collaborate with stakeholders through remote and on-siteinteractions. • Implement strategies to shorten disability duration and support timely return-to-work. • Provide specialized guidance for catastrophic cases. • Develop and implement cost-containment measures without compromising quality of care. • Serve as a clinical liaison for both legal and medical aspects of the claim. • Tailor case management plans to the unique needs of each injured worker. ESSENTIAL DUTIES • Conduct assessments, develop care plans, implement interventions, and evaluate injured worker progress. • Review treatment plans for medical necessity, appropriateness, and cost-effectiveness. • Make medical recommendations to examiners regarding available treatment plans and bestcourse of action for a safe return-to-work. • Arrange and coordinate services such as appointment, diagnostic tests, therapy, and durablemedical equipment. • Develop cost-efficient strategies to optimize patient outcomes. • Prepare clear, organized reports within established deadlines. • Communicate extensively via telephone to manage cases and coordinate care. • Call injured workers post-visit to gather key details (treatment plan, wait time, face-to-face minutes, follow-ups) • Document interactions and route updates to adjusters/clients promptly • Complete daily tasks by sending out letters, emails, fax and maintain medical detailed records. • Perform field assignments on an as-needed basis to ensure continuity of care. • Acts as an HCO and MPN resource for claims. • Manages telephonic and field caseload of 40 – 50 indemnity and medical only files. • Prepares and presents documents and information for file reviews, case studies, etc • Participating in audits, accreditations, and other quality assurance functions • Supporting other units as needed. • Performing other duties as assigned. • Supporting the organization's quality assurance program(s). PHYSICAL ACTIVITY • Requires extended periods of sitting, phone work, and data entry. • Ability to travel to attend occasional events such as conferences, trainings, and field nurse case management assignments. • Lifting up to 20 pounds. REQUIRED QUALIFICATIONS • Valid and unrestricted compact LVN license • Meticulous attention to detail (accurate documentation, follow-through, time management) • Proficiency in Microsoft Office, keyboarding, EMRs, CMSs, cloud-based databases, Outlook/Teams, Excel basics and other computer-based programs essential to efficient remote work • Strong customer service mindset (professional, calm, solutions-oriented on calls) • Clear written and verbal communication • Reliable judgment/triage sense; escalates issues appropriately • 40-60 wpm typing speed • Team player; dependable, punctual • Ability to work independently, analyze medical information and arrive at sound clinical decisions related to continuing medical treatment • Demonstrated experience collaborating and communicating with physicians • Must be able to handle sensitive and confidential information with the highest degree of professionalism • Capable of multitasking and meeting deadlines • Ability to work remotely, including high-speed internet with enough available bandwidth for work purposes, reliable cell phone or landline access, secure and ergonomic work space. • Must be bilingual with ability to speak, read and write in Spanish PREFERRED QUALIFICATIONS • Prior experience in Workers’ Compensation, medical case management/nurse case management, or UR/UM • Familiarity with MTUS/ODG terms and common clinic/diagnostic workflows • Supervisory or other leadership experience in professional setting • Case Management certification or other relevant certifications ABOUT MEDEX MEDEX is based in Newport Beach, California, and we’re continuing a sustainable trajectory of growth since our founding in 1994. Serving some of the nation's largest and most recognizable companies, we strive to be the simple, strategic, and smart solution to our clients' Workers' Compensation woes. Our success comes from providing employers with a secret weapon to battle the inefficient costs of Workers' Compensation claims in California. Our HCO+MPN provider networks are the most unique and powerful medical cost control tool in the industry. Supporting our boutique networks are our industry-leading Managed Care and Medical Management services. At MEDEX, we're proud to have a wide range of professionals on staff, including physicians, customer service specialists, nurses, data analysts, attorneys, and other valuable experts. According to a recent survey, 100% of responding MEDEX employees feel that they are doing meaningful work every day, feel positive coming to the office in the morning, and have an optimistic view about the company's future. MEDEX employees also rated the company 4.5 out of 5 stars as an employer. That's because we're in the sweet spot so many job seekers are looking for: small enough to have a family-like atmosphere but large enough to have the resources to provide employees with great benefits and opportunities for growth. We are always excited to welcome knowledgeable, committed, and engaged new members to the team! Job Type: Full-time Pay: $27.00 - $33.00 per hour Benefits: • 401(k) • Dental insurance • Disability insurance • Health insurance • Life insurance • Mileage reimbursement • Paid time off • Vision insurance Application Question(s): • Do you live in any of the following states; Idaho, Washington, Arizona, New Mexico, or Texas? • Do you have a valid unrestricted compact LVN license? Language: • Spanish (Required) Work Location: Remote Apply tot his job Apply To this Job