Telephonic Nurse Case Manager position at MCMC llc in Las Vegas

MCMC llc is presently looking of Telephonic Nurse Case Manager on Mon, 15 Jul 2013 03:00:13 GMT. What We Do: MCMC's success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping MCMC grow each year. Because of our tremendous growth, we are always in search of outstanding individuals. Telephonic Case Manager Summary: To oversee managed care process and to ensure that managed care activities are performed in accordance with...

Telephonic Nurse Case Manager

Location: Las Vegas Nevada

Description: MCMC llc is presently looking of Telephonic Nurse Case Manager right now, this position will be placed in Nevada. Further informations about this position opportunity kindly read the description below. What We Do:
MCMC's success can be attributed to our diverse and talented work force. Our employees are the foundation of our business and are helping MCMC grow each year.

! Because of our tremendous growth, we are always in search of outstanding individuals.

Telephonic Case Manager

Summary:
To oversee managed care process and to ensure that managed care activities are performed in accordance with state-mandated regulations and/or client guidelines. To provide telephonic medical management for active claims by assessing, planning, facilitating and advocating the health needs of an injured worker.

Responsibilities:

• Assessment of the individual’s personal and medical history, current status, prognosis, current treatment plans and care provider's level of expertise.
• Determines appropriateness of care, quality of care, and timeliness of testing within accepted medical guidelines (eg MDA, ODG)
• Identifies significant case activity to be reported to the client.
• Identifies case management issues for initiation of Case Management process.
• Identifies and refe! rs cases to the MCMC Review Physicians for review and peer con! tact with the treating provider, consistent with company and client guidelines.
• Recognizes and addresses medical and non-medical issues which may adversely impact employee recovery and case resolution.
• Identifies appropriate intervention, and alternate, cost effective treatment modalities in order to promote recovery and timely return to work.
• Communicates with the treating provider regarding indications for potential treatment and diagnostic studies.
• Supports and assists injured workers and their families to navigate through the complex array of health, rehabilitation, vocational training, mental health and substance abuse services and programs.
• Serves as a liaison with the claims administration staff and treating provider staff to facilitate maximum benefit and promote recovery.
• Ongoing promotion and maintenance of quality assurance standards from a Case Review/Case Management standpoint, as well as in the provision of! customer service.
• Works with Onsite Case Managers, as needed, to facilitate employee's maximal recovery, return to work, and timely case disposition and resolution.
• Works with MCMC Review Physician on issues requiring contact with the Treatment Provider to facilitate quality, timely, cost effective treatment and promote return to work.
• Intervenes promptly on significant cases with high dollar potential to coordinate care and appropriate referrals for the promotion of optimal treatment.
• Identifies any temporary or permanent alterations in function that have resulted from the current injury
• Identifies potential challenges or complications in physiological and/or psychosocial function.
• Ensures that all documentation is current, timely, grammatically correct, consistent and appropriately reflects the sense of circumstances of the case. Documentation must also adhere to company practices.
• Participates in ongoing tra! ining meetings and inservices.
• Acts as a member of a team and ! provides coverage on temporary or permanent basis to other accounts as assigned.
• Identifies and addresses medical and non-medical issues which may adversely impact employee recovery and case resolution.
• Intervenes promptly on significant cases with high dollar potential to coordinate care and appropriate referrals for the promotion of optimal treatment.
• Other duties as assigned.

Qualifications:

• Ability to work independently, as well as cooperatively with others.
• Experience dealing with multiple tasks, and problem solving under pressure.
• Exposure to and familiarity with computer systems desired.
• Exposure to and familiarity with state regulations governing work related injury claims administration, and with third party reimbursement, when applicable.
• Strong interpersonal skills, including oral and written communications.
• Maintenance of continuing education appropriate to cas! e management, Workers' Compensation issues
• Demonstrated accountability and skills in analysis, decision making and time management
• Bilingual in English/Spanish is desired, but not required

Experience:

• Registered Nurse, Current Nevada State Licensure. May consider certified rehab counselor . NEED RN CCM is desired/willingness to obtain.
• Minimum 3-5 years of acute clinical experience preferred
• Must have strong background, consisting of three or more year’s experience in Workers' Compensation injury management, from an Occupational Health, Utilization Review or Rehabilitation preferred.

Please send resumes to:
MCMC LLC
Attn: Human Resources
300 Crown Colony Drive, Suite 203
Quincy, MA 02169

Fax: 877-791-5970
E-mail: MA.HR@mcmcllc.com

An Equal Opportunity Employer
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If you were eligible to this position, please email us! your resume, with salary requirements and a resume to MCMC llc.

If you interested on this position just click on the Apply button, you will be redirected to the official website

This position starts available on: Mon, 15 Jul 2013 03:00:13 GMT

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