CCMSI

Nurse Case Manager

US-NM-Albuquerque
Job ID
2017-2146
Category
Nursing

Overview

Cannon Cochran Management Services, Inc. (CCMSI) is a leading Third Party Administrator in self-insurance services headquartered in Danville, IL.  We are guided by core values including integrity, insisting on excellence and being passionately focused on customer service.  Those values, coupled with our Employee Stock Ownership Plan (ESOP), engage ownership with our employees and offers top of the line customer service for both our internal and external clients. 

 

This is a perfect opportunity to work in a growing, dynamic work environment.  CCMSI’s emphasis is on customer service and you will be expected to set and achieve performance goals in a challenging and growing team environment. 

 

The Nurse Case Manager is responsible for comprehensive case management of assigned case files, acting as a resource for all involved parties. Creates flexible, cost effective options for work-injured individuals to facilitate quality of care, to create individualized treatment goals, and to achieve the best possible outcomes. Responsible for assuring the claimants’ care is appropriate, cost effective and leads toward rapid and safe return to work and maximum medical improvement.

Responsibilities

  • Reviews all assigned files to assess the claimant’s medical needs, work status and present condition in order to develop and document an action plan for each referred claim.
  • Acts as a facilitator to injured worker, employer, provider, adjuster, and attorney where allowed, fostering non-adversarial relationships while moving towards maximum medical improvement, safe early return to work, and file closure. The case manager monitors treatment and works in conjunction with the adjuster in accordance with CCMSI’s claims management guidelines and utilization management programs.
  • Reviews all medical records/documentation for medical necessity and appropriateness of care. Works with all parties involved in the management of the claim to formulate a plan for rapid, safe, and whenever possible, early return to work. Documents cost savings and bills accurately for all work performed
  • Participates in problem solving to develop an effective strategy for claim closure.
  • Maintains the file in accordance with CCMSI’s claims handling guidelines and incorporates the essential activities of case management as defined by his/her Certification guidelines throughout the medical case management process on each file.
  • Develops the medical case management plan for each claim in conjunction with the adjuster. Each managed claim should contain individually focused, functionally oriented treatment plans. Maintains a close working relationship with all parties involved in the claim as allowed per state jurisdiction.
  • Makes recommendations for referrals when necessary and appropriate, for independent medical evaluation, treatment, consultation, second opinion, site evaluations, etc
  • Supports and fosters a team building environment for all internal and external customers, assuring that their needs are met in a timely and efficient manner.
  • Performs other duties as assigned.

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, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Excellent verbal and written communication and interpersonal skills required. Ability to manage multiple and changing priorities with skill and dignity. Attention to detail, planning and documentation. Discretion and confidentiality is a must. Knowledge of case management philosophy, process, outcomes and goals.

 

Reliable, predictable attendance within client service hours for the performance of this position.

 

Responsive to internal and external client needs.

 

Ability to clearly communicate verbally and/or in writing both internally and externally.

 

Education and/or Experience                                                                    

RN preferred BSN 3-5  years of clinical experience related to Trauma, Rehabilitation Therapy, Orthopedics, Workers’ Compensation Occupational Medicine Medical Surgical.

 

Computer Skills                                                                           

Proficient with Microsoft Office programs. 

 

Certificates, Licenses, Registrations  

Current Jurisdictional Nursing license required.

 

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.

 

 

Object Handling Categories

Work requires the ability to lift/carry objects routinely as follows:

      

Light Lifting: No lifting of objects weighing more than 15 pounds on a regular basis.

  

 

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

 

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.

 

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