Assesses the medical and/or vocational components of injured worker's situation including, but not limited to, prior authorization, determination of appropriate level of care and utilization of services, concurrent review, retrospective review, development of discharge plans and assurance of quality and cost effectiveness. Acts as a liaison among patient/family, employer, insurance company, and healthcare personnel to ensure necessary care is provided promptly and effectively to restore injured worker's function, capacity and self-esteem.
MAJOR DUTIES AND RESPONSIBILITIES:
Assesses and analyzes injured worker's medical and/or vocational status and develops a viable, realistic service plan.
o Meets with clients in their homes, work-sites, physician's or therapist's office to provide on going case management services.
o Develops a plan of care for patients from admission to discharge.
o Monitors patient progress toward desired outcomes through assessments and evaluations.
o Communicates both in-person and telephonically with client, medical providers, attorneys, employers, insurance carriers, etc.
o Develops and administers education and prevention programs.
o Develops guidelines for working with patients, healthcare management companies, insurance companies or other third party payers to determine quality, cost-effective care. Applies all special instructions required by individual insurance carriers and referral sources.
o Applies all laws and regulations that apply to the provision of rehabilitation services.
o Testifies when called upon to do so, to substantiate any casework or reports that may be seen as relevant to hearing involving client.
o Evaluates outcome of patient care.
o Prepares reports and other required paperwork as documentation of all casework activities.
o May arrange referrals, consultations, therapeutic services, and confers with other specialists on course of care and treatment.
o Implement, calculate and document cost savings measures
Licensed RN in accordance with state laws of jurisdiction.
State certifications in accordance with state laws of jurisdiction, i.e. QRP in Florida
Obtaining and maintaining, CCM, CIRS, CDMS, CRRN or CRC designations are encouraged; these designations are required where dictated by state regulations.