DEPARTMENT: Clinical Services
SUPERVISED BY: COO
and medically manages a range of health care services to designated clients
through telephonic communication with patients, employers, providers,
adjusters, and others to determine if treatment is medically necessary,
appropriate, and effective, and to secure a timely return to work status for
- Supports the Mission, Values and Vision of Home Care Connect.
- Knowledgeable of injured worker’s rights and ensures an atmosphere which allows for the privacy, dignity and well-being of that injured worker.
- Supports, cooperates with, and implements specific procedures and programs for:
- Confidentiality of all data, including injured worker’s demographics, employee and operations data.
- Quality Assurance and compliance with all regulatory requirements.
- Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior.
- Supports and participates in common teamwork:
- Cooperates and works together with all co-workers; plans and completes job duties with minimal supervisory direction, including appropriate judgment.
- Bilingual: Spanish-English
- Uses tactful, appropriate communications in sensitive and emotional situations.
- Follows up as appropriate with supervisor, co-workers or residents regarding reported complaints, problems and concerns.
- Promotes positive public relations with co-workers, referral sources and Home Health providers.
- Completes requirements for in-service training, acceptable attendance, and dress codes including personal hygiene, and other work duties as assigned.
- Communicates effectively with providers, patients, Peer Physicians, case managers and others involved in the Case management process as needed.
- Collaborates effectively to promote the integration of all Departments and products through interdepartmental referrals and communication.
- Plans and organizes individual caseload to meet jurisdictional and Best Practice Standards for timeliness, notification and documentation requirements.
- Utilizes appropriate desktop resources to perform the case management process.
- Analyzes medical information and applies evidenced based established guidelines to facilitate the case management process.
- Documents pertinent information in the case file notes to support case management interventions and case resolution.
- Researches, reviews and prepares medical information to present and collaborate objectively with case managers and adjusters in order to facilitate case resolution.
- Promotes excellence of the case management product by participation in the QA process and through active participation in the Department’s process improvement efforts.
- Independently approaches problem resolution by appropriate use of research and resources.
- Precept new staff within the department as requested.
- Demonstrates excellent customer service, and respect for customers, co-workers and management.
- Assists with on-call duties on assigned week nights or weekends and is compensated accordingly.
tasks which are supportive in nature to the essential functions of the job, but
which may be
RN/LPN state licensure in good
standing with the State Board of Nursing.
Three (3) years hospital/clinical
experience in Orthopedics, Neurology, Occupational Health, Med/Surg or other
Skill(s): Bilingual Spanish-English. Proficient reading, writing,
grammar, and mathematics skills; knowledge of medical terminology; good
interpersonal relations and communicative skills; moderate PC skills with
emphasis on accuracy; good organizational skills.
Experience: Previous Work Comp Case Management experience desirable.
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.
While performing the duties of this
job, the employee is regularly required to talk and hear. Talking includes
expressing or exchanging ideas by means of the spoken word and any activities
in which they must convey detailed or important spoken instructions to other
workers accurately, loudly, or quickly. Hearing includes perceiving the nature
of sounds at normal speaking levels with or without correction and the ability
to receive detailed information through oral communication, and to make the
discriminations in sound.
The employee frequently is required
to sit, move throughout the office, use hands to type, handle or feel, and
reach with hands and arms.
Specific vision abilities required
by this job include close vision and ability to adjust focus. Employee is
required to have close visual acuity to perform an activity such as: preparing
and analyzing data and figures; transcribing and viewing a computer
TRAVEL: No travel is required.
JOB LOCATION: This job operates in a professional office environment.
USED IN THE PERFORMANCE OF THIS JOB
incumbent must maintain skills necessary to safely and efficiently operate the
following equipment and machines used in the performance of this job: