Bi-Lingual (Spanish) Field Nurse Case Manager

Eagle One Case Management Services, Inc.

Job Description

Job Title: Medical Case Manager (Bi-Lingual - Spanish)

Reports To: Supervisor

Department: Nursing

Summary

Provides nursing, clinical, casework services by performing the following duties:

Essential Duties and Job Responsibilities:

• Effectively manages a caseload of 25-30 active field case management files if full field, 45-55 telephonic case management files, or 30-40 if mixed TCM/FCM depending on complexity
• All full time medical case managers are required to bill a minimum of 40 hours per week or 161 hours per month
• Follows all protocols for completion of daily production sheets
• Maintains the Outlook calendar by keeping all meetings and/or appointments current and documenting changes as they occur, throughout the week, that will be available for weekly review
• Tasks must be kept current and be updated on a daily basis
• Attends and participates in all mandatory meetings and in-services
• Initial four-point contacts must be made within 24-48 hours from the date of the referral and the initial email must be sent immediately thereafter
• Closes cases and completes all mandatory fields in Outlook and in the Company charting system per protocol
• Understands and demonstrates the ability to apply Eagle One™ case management protocols
• Consults with Manager on case strategy as needed
• Carbon copies the Manager on any documentation relating to initial assignment, claim barriers/complex cases or any case resolution issues
• Demonstrates the ability to effectively create medical timelines as requested per protocol
• Prepares case summaries for account claim reviews
• Responsible for maintaining a complete medical file which is kept in chronological order with no duplication of information in a paperless format
• Alerts Manager of any requests to deviate from Eagle One™ or account specific protocols and obtains approval to proceed as necessary
• Responsible for adding providers, therapy, hospitals, etc… into Eagle One provider network, per protocol
• Utilizes appropriate cost management programs per account or company protocol (i.e., Pharmacy, DME, etc.)
• Responsible for initial and ongoing analysis of the diagnosis as it relates to the work injury and the medical treatment rendered
• If compensability has not been determined at the time of the referral, contacts the claims adjuster to discuss plan of action prior to any three-point contact
• Requests and follows up for medical records and sends releases of information when necessary; once medical records are received they are reviewed and forwarded per protocol
• Provides expert consultation for interpretation of medical information and how it impacts the case
• Projects anticipated dates for modified and full-duty work releases utilizing disability/medical criteria and documenting any deviations at each appointment
• Continually addresses physical job demands and job availability at physician appointments to encourage appropriate work release
• Contacts medical providers within 24 hours of appointments to obtain disability and medical status
• Determines and documents appropriateness of medical treatment and whether or not the treatment meets disability/medical criteria
• Updates employer and any other appropriate parties with any change in disability or medical status and appointment information within 24 hours of appointment date and coordinates return to work per protocol
• Makes appropriate contacts with attorney once notified of legal involvement
• Identifies the need for job analysis and obtains manager approval before proceeding; coordinates JA as appropriate
• Recommends and coordinates Independent Medical Examinations/Second Opinions when appropriate and assists in the selection of an appropriate specialist with all parties
• Prepares files and composes the medical questions to be included in the IME/2nd Opinion cover letter (needs to obtain manager approval prior to sending)
• Generates letters for initial physical therapy appointments and physician appointments (excluding routine clinic appointments)
• Completes state forms in a timely manner and as required by jurisdiction
• Update outcome information and general forms as changes occur but at least every few months
• Case logs must be kept updated at all times
• Adheres to jurisdictional rules and regulations and applies to each case as appropriate
• Attends all field visits as requested by client and account protocols and/or is available for field visits as needed, per Account Instructions and at client request, within an average 2 hour radius from home office.
• Meets or exceeds Eagle One™ guidelines for return-to-work outcomes and medical closure durations
• Involved in Public Health community wellness fairs and clinics as needed

Qualifications

To perform this job successfully, an individual must be detail-oriented with exceptional communication and interpersonal skills. Nurse must also have exceptional writing skills for reports as well as comfortability navigating a computer. 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:

Fifth year college or university program certificate; or two to four years related experience and/or training; or equivalent combination of education and experience.

Language Ability:

Ability to read, analyze, and interpret common scientific and technical journals, financial reports, medical reports and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format.

Math Ability:

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.

Reasoning Ability:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft Windows/Office (Word, Excel and Outlook), be able to navigate the internet for the purpose of research and have a general/overall working knowledge of computer navigation.

Certificates and Licenses:

· Medical Terminology

· Active RN licensure in state of employment

· Bachelor’s Degree preferred

· Additional certifications a plus (i.e. CCM, CDMS, CLNC)

· Knowledge of workers’ compensation jurisdictional rules/regulations a plus

· Ability to work in a fast-paced environment

· Typing skills of 45+ w.p.m.

· Strong organizational skills a must

· Excellent written and verbal communication skills

· Excellent customer service skills required

· Previous case management experience a plus

· Clinical experience in an orthopedic or occupational health setting a plus

· Bilingual a plus

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.

Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.

Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.

Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

Supervisory Responsibilities:

This job has no supervisory responsibilities.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

The noise level in the work environment is usually moderate.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must frequently lift and/or move up to 10 pounds.

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee is frequently required to stand; walk; sit and reach with hands and arms. The employee is occasionally required to stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.