Status: Full-time position
Location: Albuquerque, NM
Job Summary: To perform initial and ongoing clinical assessment and evaluate need for alternative treatment; to negotiate and coordinate appropriate medical treatment and length of disability with providers and employers; and to implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
Qualifications: Education & Licensing
Active RN license(s) required. Baccalaureate degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
Two (2) years of full-time equivalent of direct clinical care to the consumer required.
Skills & Knowledge
Knowledge of workers compensation laws and regulations
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Duties: 1.Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assessment of client's situation will include psychosocial needs, cultural implications and support systems in place.
2.Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidenced-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
3.Evaluates need for alternative treatment.
4.Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
5.Negotiates and coordinates a prompt return-to-work with employer.
6.Measures interventions to determine the outcomes of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.
7.Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
8.Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.
9.Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
For more information about this position or how to apply please visit http://www.newmexicodiversity.com/j/t-Case-Management-Specialist--RN-e-Sedgwick-Claims-Management-Services-Inc-l-Albuquerque,-NM-jobs-j5089966.html