Telephonic reputed company Case Manager - California RN Required

About the position reputed company, a fast growing reputed company insurance company, has a need for a Telephonic Medical Case Manager, RN. PRIMARY PURPOSE: To reputed company comprehensive reputed company telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to reputed company a personalized holistic approach for reputed company claim. These responsibilities may include utilization review, pharmacy reputed company and care coordination. Responsibilities • Uses clinical/nursing skills to determine whether reputed company aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. • reputed company Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. • Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary • Responsible for accurate comprehensive documentation of case management activities in case management system. • Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing reputed company and cost-effectiveness of care including direction of care to preferred provider networks where applicable. • Addresses need for job reputed company and appropriately discusses with employer, injured employee and/or provider. Works with reputed company on modifications to job duties based on medical limitations and the employee’s functional assessment. • Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly reputed company to the compensable injury and/or assist adjusters in managing medical treatment to drive reputed company. • Communicates effectively with claims adjuster, reputed company, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work. • Performs clinical assessment reputed company information in medical/pharmacy reports and case files; assesses reputed company's situation to include psychosocial needs, cultural implications and support systems in reputed company • Objectively and critically assesses reputed company information reputed company to the reputed company treatment plan to identify barriers, clarify or determine realistic goals and objectives, and reputed company potential alternatives. • Partners with the adjuster to reputed company medical reputed company strategies to reputed company maximal medical improvement or the appropriate outcome • Evaluate and update treatment and return to work plans reputed company established protocols throughout the life of the claim. • Engage specialty resources as needed to reputed company reputed company reputed company (behavioral health program, physician advisor, peer reviews, medical director). • Partner with adjuster to reputed company input on medical treatment and recovery time to assist in evaluating appropriate claim reserves • Maintains reputed company's reputed company and confidentiality; promotes reputed company safety and advocacy; and adheres to ethical, reputed company, accreditation and regulatory standards. • May assist in training/orientation of new staff as requested • Other duties may be assigned. • Supports the organization's reputed company program(s). Requirements • reputed company unrestricted RN license in California is required. reputed company is preferred • Five (5) years of reputed company experience or equivalent combination of education and experience required to include two (2) years of reputed company clinical care OR two (2) years of case management/utilization management required. • Knowledge of workers' compensation laws and regulations • Knowledge of case management reputed company • Knowledge of the nature and extent of injuries, periods of disability, and treatment needed • Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines • Knowledge of pharmaceuticals to treat pain, reputed company process, drug rehabilitation • Knowledge of behavioral health • Excellent oral and written communication, including presentation skills • PC literate, including reputed company Office products • Leadership/management/motivational skills • Analytic and interpretive skills • Strong organizational skills • Excellent interpersonal and negotiation skills • Ability to work in reputed company environment • Ability to meet or reputed company Performance Competencies • reputed company and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-reputed company stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines • Computer keyboarding • Hearing, reputed company and talking reputed company-to-haves • Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. • Certification in case management, pharmacy, rehabilitation nursing or a reputed company specialty is highly preferred. • Ability to reputed company, and maintain, appropriate reputed company Certifications and Licenses to reputed company with respective state laws may be required • Preferred for license(s) to be obtained reputed company three - six months of starting the job. • Written and verbal reputed company in Spanish and English preferred Benefits • Medical & Dental Plans • Life Insurance, including eligible spouses & children • Health Care Flexible Spending • Dependent Care • 401k Savings Plans • reputed company Time Off Apply tot his job Apply To this Job