JOB TITLE: Nurse Case Manager

PURPOSE:
To provide professional evaluation and assessment in medical case management and vocational restoration of persons with disabilities. To achieve a medically proactive and cost effective action plan with the highest attainable medical outcomes and reasonable rehabilitative results.

DUTIES AND RESPONSIBILITIES:

REPORTS TO: Nursing Manager

ASSESSMENT

1. Evaluates persons with disability potential, via telephonic assessment or personal interview, review of clinical information from treating physician, or during a personal visitation with the physician or injured person.
2. Apply appropriate data driven subjective and objective criteria to identify the injured person's needs.

PLANNING

1. Formulates, with the injured persons and medical staff, an appropriate and comprehensive plan of action for the rehabilitative process; providing for best interests of the injured persons, collaterals and clients.
2. Develops individualized care plans from collection of objective data, communications with medical staff, and injured persons.
3. Utilizes accepted guidelines for care plans, using guidelines for time-specific anticipated progress in rehabilitation from a specific injury.

IMPLEMENTATION

1. Implements plan of action, in agreement with the injured person's physician, following industry standard guidelines and procedures. Follows up on and revises plans as necessary according to guidelines.
2. Communicates with claims analysts of anticipated and actual disability status, progress, transition to modified or full duty position, and communicates ability to return to pre-injury occupations or need for vocational process.
3. Offers consultation services in utilization management when requested by claims analysts and appropriates services to maintain cost-effectiveness though approved providers.
4. Attends physician visits with injured persons to provide opportunities for collaboration and coordination of services and treatment plans; dialogues with the physician to facilitate appropriate medical treatment and provide authorizations to implement services as authorized.

COORDINATION

1. Encourages and instigates dialogue between the injured person, physician, employer and claims analysts. Communicates with injured persons' attorney as needed.
2. Provides consultation to all claims persons to assist in understanding of complex medical terminology, technology and treatments, and cost projections.
3. Maintains and fosters the best possible relationships with the medical community and contracted providers to facilitate the most appropriate, cost-effective care, equipment, and supplies for the injured person.
4. Identifies and establishes liaison relationships with the medical community, rehabilitation and treatment teams, multi-disciplinarian teams, custodial care facilities, transportation providers, equipment and service providers, home care providers or assisted living organizations being utilized on assigned cases.
5. Independently assumes responsibility to be knowledgeable on workers' compensation laws and disability benefits, utilization management, and rehabilitation for specific clients.

MONITORING

1. Follows up on and revises action plans as necessary according to guidelines of changes in status.
2. Maintains confidentiality of injured workers' medical, disability, and demographic information
3. Prepares and submits initial and case management reports. Evaluates injured persons' progress toward estimated return to pre-injury status and potential for return to work.
4. Communicates with transitional work programs on the injured persons' physical and psychological readiness for transition to modified work, and facilitates the injured person in meeting treatment goals.

EVALUATION

1. Collects utilization data and compares effectiveness of case management activities. Evaluates achievement of case management goals with continual re-assessment to achieve medical and vocational outcomes.
2. Evaluates medical disabilities and prepares effective and pro-active solutions to facilitate early and appropriate treatment and timely restoration of function and pre-injury abilities.
3. Evaluates and recommends solutions to personal injury management through empowerment of the injured person as part of the medical and rehabilitative process.
4. Evaluates current disability status according to appropriate guidelines and maintains continued dialogue with the physician while utilizing guidelines to assist in return to physical activities.
5. Prepares cost benefit information for individual cases.