Nurse Case Manager
IPMG
full-time
Posted on:
Location Type: Remote
Location: Illinois • United States
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Salary
💰 $87,000 - $112,000 per year
About the role
- Conducts initial and ongoing assessments to identify patient status and individual needs; promotes client self-determination
- Assists in identifying appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source.
- Utilizes appropriate resources and case management interventions to facilitate the case management plan and to allow for the individual’s optimum level of wellness and functional capability with quality cost-effective outcomes appropriate to health plan and workers’ compensation
- Develops a specific case management plan in collaboration with the consumer and members of the health care team with periodic updates.
- Identifies short term goals, long term goals, interventions to meet goals, resources to be utilized, timeframes for re-evaluations, and collaborative approaches to facilitate the case management plan
- Executes and documents specific case management activities and/or interventions that will lead to accomplishing the goals set forth in the case management plan
- Gathers sufficient information from all relevant sources and its documentation regarding the case management plan and its activities and/or services to enable the determination of the plan’s effectiveness
- Evaluates at appropriate intervals, determining and documenting the case management plan’s effectiveness in reaching desired outcomes and goals with modifications, as appropriate
- Measures and modifies the interventions to determine the outcomes of the case management involvement
- Implements care plan by facilitating authorizations and referrals, as appropriate, within benefit structure, contractual agreements or jurisdictional regulations; utilizing nationally accepted evidence based criteria as guidelines for treatment protocols
- Documents all contacts according to Best Practices, utilizing templates, as required
- Notifies claims personnel regarding anticipated surgeries, benefit exceptions, and other significant events that may require special handling
- Manages the disability durations proactively, utilizing nationally accepted evidence based criteria as guidelines for duration protocols in workers’ compensation and short term disability
- Collaborates and communicates effectively with patients/injured workers, providers, client, employers, and internal team members
- Performs triage intake functions with referrals and coordination of care needs specific to client instructions.
- Performs leave administration and short term disability management according to regulations, policies, and plan documents
Requirements
- Current registered nurse (RN) License
- 2 years of clinical experience
- Excellent written and verbal communication skills
- Proven customer service skills
- Effective time management skills
- Overall computer proficiency including expertise in Microsoft Office Suite, especially Outlook, Word, and Excel
- Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline.
- Two years full-time equivalent of direct clinical care to the consumer;
- Certification as a case manager from the URAC-approved list of certifications; or A bachelor’s or higher degree in a health or human services related field; or A current registered nurse (RN) license
- Willingness to obtain advanced certification, when eligible
- Willingness to obtain additional state licensure, as required by business needs.
Benefits
- Generous Time off
- You'll start with 20 days of PTO, paid holidays, paid Birthday off
- Medical, dental, and vision coverage on day one of full-time employment, including telemedicine if you are on our medical plan
- 401k match
- Professional development support and a Linkedin Learning subscription
- Flexible time off with an encouraged time away to support a healthy work-life balance
- Life Insurance, Short term, and long-term disability on day one of full-time employment and paid for by IPMG
- Onsite fitness center and showers, in our St. Charles, IL HQ office
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementclinical assessmentcare plan implementationdocumentationdisability managementgoal settingintervention measurementtriage intakereferral coordinationevidence-based criteria
Soft Skills
communication skillscustomer servicetime managementcollaborationself-determination promotionorganizational skillsproblem-solvingadaptabilitycritical thinkinginterpersonal skills
Certifications
Registered Nurse (RN) Licensecase manager certificationhealth or human services licensureadvanced certification (willingness to obtain)state licensure (willingness to obtain)