Nurse Case Manager at TRIUNE Health Group Inc
Los Angeles, CA 90001
About the Job
I. Summary of Position:
The Nurse Case Manager coordinates resources and creates flexible cost effective options for catastrophically or chronically ill or injured individuals to facilitate quality individualized holistic treatment goals, including timely return to work when appropriate.
II. Essential Duties and Responsibilities:
- Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer and the referral source.
- Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation and outcome of individual's progress.
- Evaluate individual treatment plan for appropriateness, medical necessity, and cost effectiveness.
- Facilitates care such as negotiating and coordinating the delivery of durable medical equipment and home health services.
- Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinates architectural assessment of patient's home when required.
- Read extensively and stay current with medical terminology and the federal and state law relating to health care, Workers Compensation, ADA, HIPPA, FMLA, STD, LTD, SSDI, SSA.
- Utilize technology (computer, cell phone, fax and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPPA.
- Research medical and community resources for individuals with catastrophic or chronic diagnoses such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, burns, etc
- Possess a valid driver's license with the ability to travel 90% of the time.
- Perform other duties as assigned.
III. Job 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.
Skills and Abilities:
- Proven leadership skills.
- Excellent verbal and written communication skills, including the ability to interact well with customers, and fellow employees via the phone, email, in-person, and formal presentations.
- Methodical in accomplishing job-related goals.
- Strong analytical and organizational skills, including the ability to multitask with attention to detail.
- In-depth knowledge of multi-software packages, most notably Microsoft Office Suite (mainly Word, Excel, PowerPoint, Outlook) and the Internet.
- Maintain a friendly, professional attitude at all times.
- Exercise initiative and be solution oriented, while keeping Management up-to-date on current situations or opportunities.
- Dependability and adaptability.
Education and Experience:
- Graduate of an accredited school of nursing.
- Current RN licensure in the state of operation.
- Three or more years of recent clinical experience, preferably in the areas of trauma, psychology, emergency, orthopedics, rehabilitation, occupational health and neurology.
- CCM Preferred
Certificates, Licenses, Registrations: While not mandatory, an individual with one or a combination of the following certifications is preferred: COHN, COHN-S, and CDMS.
IV. 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.
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