Remote Case Manager; RN

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Remote Case Manager RN

The Leading Provider of Integrated Occupational Medicine Services, CORE Health Networks, provides integrated solutions to occupational healthcare needs. Our programs align with each client’s missions, goals, and values to achieve outcomes and exceed expectations. We are expanding our team and currently seek a full-time Case Manager (Registered Nurse) to work from home, Monday through Friday, 8:30am to 5:00pm Central Time. We offer a comprehensive compensation package including Health, Dental, Vision, Life, 401(k), six paid holidays, vacation and sick leave, long-term disability, short-term disability, and more.

To learn more about this opportunity, review the job specifications below.

Under the direction of the Director of Injury Management, the Case Manager administers intake of calls from contracted clients, an injured worker, Worker’s Compensation Insurance adjusters, medical providers, and clinic staff. Provides exceptional service and quality treatment options to the patient and client throughout the injury management life-cycle.

• Triage injury/illness calls to determine emergent vs non-emergent needs.
• Determine if injury/illness requires immediate treatment or first aid advice.
• Research/locate the nearest facility to utilize for injury.
• Contact medical facility to determine availability of adequate services; coordinate visit via phone/fax.
• Speak with medical personnel regarding mechanism of injury/illness; discuss appropriate treatment pathways, obtain UDS and BAT when applicable, and assess workplace accommodation availability.
• Inform client/injured worker of the name, location, and contact information of available medical facilities.
• Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation.
• Provide updates of diagnosis, work status, plan of care, and follow-up appointments to appropriate personnel, including the injured worker’s employer and adjuster.
• Provide updates, diagnosis, clinic notes, and treatment authorization requests to designated representatives for client and Worker’s Compensation insurance adjusters.
• Log injury/illness details on client-specific spreadsheets.
• Enter injured worker, adjuster name, and claim number into Billing Portal; apply billing time and track status of case as it occurs.
• Bill time for each case according to services rendered.
• Field Case Management services for clients/injured workers needing onsite CM services; coordinate with provider and obtain pertinent paperwork at the visit.
• Generate letters to providers to clarify work-relatedness or treatment plans.
• Obtain and review medical records and diagnostics related to present injury/illness, prior history, and/or forward to specialty providers when allocated.
• Document phone calls, interpretation of medical records, work status, and emails related to each case.
• Coordinate SMOs with specialists as needed.
• Coordinate FCEs to determine job capabilities.
• Rotate call coverage to ensure 24/7/365 CM services; perform duties as stated above for incoming calls.
• Transfer phone line coverage each morning and evening.
• Assist Upper Management in CM activities as requested.
• Answer phones professionally when receptionist is not available.
• Attend and participate in staff meetings.
• Assist in office-related tasks as needed.
• Participate in learning and skill development opportunities, including internal and external training and workshops.
• Other duties as assigned by supervisors.

• High School Diploma or GED required; completion of a vocational program leading to nursing license.

• Must possess and retain a valid RN license for the state of LA (or compact multistate license).
• Obtain a CWCP certification within two (2) years of employment.

• Minimum two (2) years of nursing experience in a clinical setting, or prior occupational health experience.
• ER, ICU or PACU experience preferred.

• Monday - Friday 8:30 a.m. – 5:00 p.m., CST. This position is remote but may require in-office…