Nurse Case Manager Job Description
Nurse Case Manager Duties & Responsibilities
To write an effective nurse case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included nurse case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Nurse Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Nurse Case Manager
List any licenses or certifications required by the position: BLS, CPR, CCM, ACM, CM, ABQAURP, URAC, AHA
Education for Nurse Case Manager
Typically a job would require a certain level of education.
Employers hiring for the nurse case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Associates, Management, Education, Graduate, Health Care, Health, Nursing Program, Science, School of Nursing
Skills for Nurse Case Manager
Desired skills for nurse case manager include:
Desired experience for nurse case manager includes:
Nurse Case Manager Examples
Nurse Case Manager Job Description
- Participates with the clinical staff in the assessment of patient needs
- Completes, compiles and assembles all required paperwork for the patient client record, chart, as per corporate Policy and Procedures
- Provides patient education regarding receipt, storage and the administration of medications and supplies
- Assists the clinical staff in obtaining orders from the physician/practitioners office, only a registered pharmacist can obtain verbal medication orders directly from the physician/practitioners office
- Provides in-service training to the clinical and facility staff
- Addresses staff and/or member groups on specific topics of concern or interest within the expertise of the Nurse
- Acts as liaison between physicians/practitioners, medical consultants and facility clinical staff
- Participates in the corporate Quality/Performance Improvement program as required, in-service programs and continuing education/training programs as required
- Participates in on-call coverage after-hours, weekends and holidays as scheduled and or requested
- Completes written and verbal consultations with all levels of the claims staff that will clearly outline the answers on functional parameters the length and severity of the medical condition(s)
- Strong clinical, interpersonal, priority setting and problem solving skills required
- Proven clinical practice experience, , hospital setting, alternative care setting such as home health or ambulatory care
- Clinically trained with Degree or recognized designation in western Medicine / Nursing or other western medical disciplines
- Minimum of one (1) year of clinical experience as a registered nurse (RN)
- Current knowledge and understanding of payments systems, HMO, PPO, Indemnity, Workers Compensation, insurance (Medicare and Medicaid
- Minimum of three years of clinical experience in applicable nursing specialty field
Nurse Case Manager Job Description
- You’ll act as a medical consultant for our internal claims department team members, providing case management services that promote employees in their return to work
- You’ll review medical record documentation so that you can assess and evaluate medical conditions and history, diagnostic/test results and treatment
- Assists in projection of reserves for the life of the claim and collaborates with adjuster for roundtables
- Assesses healthcare needs associated with compensable/covered illness/injury claims and comorbidities
- Educates and evaluates injured/ill claimant/class member, insured party, and health care provider regarding patient's response to treatment to enhance claimant adherence and progress toward maximum medical improvement Return to Work planning
- Monitors and evaluates claimants' responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
- Collaborates with physicians, other medical providers, injured claimants and claims professionals to achieve optimal outcomes
- Acts to enhance injured workers’ adherence and progress toward maximum medical improvement
- Coordinates and monitors referrals to medical management vendors, as needed
- Effectively manages assigned caseload of medical/disability cases in accordance with Michigan PIP statute and company guidelines
- Case Management expereince preferred
- Bachelor’s Degree in nursing and at least 1 year of prior nursing experience
- At least 1 year of experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary
- At least 1 year of basic Internet Explorer skills to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online
- At least 1 year of experience in identifying operational issues and recommending and implementing strategies to resolve problems
- Certification in infusion IV nursing services
Nurse Case Manager Job Description
- Interfaces with the member, family members/caregivers, and the healthcare team, internal matrix partners
- Collaborates with physicians, other medical providers, workers, employers and claims professionals to achieve optimal outcomes
- Monitors and evaluates inured workers’ responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
- Acts to enhance injured workers’ adherence and progress toward maximum medical improvement, , Return to Work planning
- Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions
- Maintains a caseload of workers’ compensation claims
- Reviews medical aspects of all workers’ compensation claims and assists the University in return-to-work of injured workers and prevention of excessive injury costs by early identification of opportunities for appropriate medical intervention
- Have expertise in job functions within Patient Services group, mentoring, training and monitoring that area of responsibility
- Provide rigorous attempts to reach employer, injured worker and medical provider including sending correspondence if injured worker cannot be reached after several attempts
- Appropriately document all correspondence, contacts and actions on a claim in XCM per RTW standards
- Bachelors degree in nursing with a valid license
- Member of O.I.I.Q
- Minimum of 3-5 years of experience in disability management
- Good knowledge of computers and Windows environment
- Analytical skills and ability to summarize information
- Member of CARNA
Nurse Case Manager Job Description
- Complete all data entry requirements for managed care activities
- Completes in a timely manner, admission and continues stay criteria review to obtain “certification” and/or continues stay approval for selected Medicare, Medicaid, commercial and managed care patients
- Is available on a rotating basis on weekends, evenings, and holidays with other staff to provide onsite services from utilization review
- Complete Risk Assessment and Obstacle and Strategy report to appropriate parties by-product
- Establish a workers’ compensation and/or disability management program with customer including identification and coordination with medical providers, internal/external claims administrators and/or other external service providers
- Coach customers to refine and improve their workers’ compensation/disability management program in areas of injury report filing and in coordination with loss prevention, supporting provision of transitional duty by assisting customers in identifying industry specific light duty options as needed
- Actively participate in strategy sessions, client check in meetings and/or dispute resolution meetings as requested
- Obtain treatment plan and facilitate injured worker’s return to work and adherence to their treatment plan
- Provide customers with a plan of action, regular communication, support on injured worker’s treatment plan, early return-to-work as soon as medically feasible and ongoing return-to-work progress
- Coordinates the injured workers' medical treatment to ensure both cost effective and medically appropriate care is provided
- Acute setting sub-acute or SNF facility experience
- Bachelor's Degree required, preferably in Nursing
- This position requires the ability to multi-task and interact with patients, family members, other staff and faculty
- Must have knowledge and understanding of case management
- Current Registered Nursing license required
- Current Certified Case Manager (CCM) or Certified Professional in Disability Management (CPDM) designation or the willingness and commitment to obtain such a designation within 2 years of hire
Nurse Case Manager Job Description
- Facilitates the return to work process by acting as a liaison between the insured, medical provider, injured worker and the claims handler
- Provides the claims handler with appropriate disability timeframes through the utilization of the Official Disability Guidelines
- Questions the causal relationship between the treatment and injury claimed
- Coordinates treatment plans for cases involving catastrophic injuries and complicated medical conditions
- Oversees Vocational Rehabilitation activities in collaboration with the claims handlers
- Prepares medical cost projections and makes reserve recommendations upon request
- Provides medical education and guidance to claims handlers on complex files
- Maintains current knowledge of medical and rehabilitation trends
- Makes scheduled outbound calls and responds to inbound calls from patients and other customers regarding clinical aspects of a product, product administration, and adherence to medical therapies or treatments or for other related issues
- Providers wrap-around case management and care coordination services between patients, healthcare providers, and various settings of care
- You’ll have a minimum of 4 years hospital or clinical experience in relevant medical fields
- Graduate of an accredited professional school of nursing required
- Active, unrestricted licensure as a Registered Nurse in Massachusetts
- Certified in Geriatric Nursing or Geriatric Case Management preferred
- Works effectively both independently member of an interdisciplinary team
- Fluency in French and French