PRIMARY FUNCTION

· Manage either workers’ compensation or auto claims appropriately and aggressively via professional communication with all parties which may include the patient, provider and insurer to expedite an early return to work and/or medical discharge.

RESPONSIBILITIES

· Perform initial assessment including history of injury/accident, ongoing treatment, social, vocational and past medical history obtained from all relevant sources. Assessment may also include cost projections, as well as treatment plan recommendations.

· Develop and implement optimal rehabilitation plans including medical, psychological, social and environmental needs, compliance to treatment plans, monitoring progress and evaluating outcomes, and arranging funding through the insurance company for treatment, equipment or other rehabilitative activities.

· Assist/Coordinate rehabilitative services applied in multiple environments such as home care, transportation, community resources, equipment, therapies, independent consultations, discharge plans and facility admissions/discharge, across a continuum of care until optimal health is reached.

· Provide physician with employer light duty policy and job descriptions, when appropriate.

· Implement effective negotiations and cost savings policies with regards to the above activities.

· Interact effectively with individuals, agencies and facilities involved in the individual’s recovery.

· Maintain case notes with appropriate information in a neat and organized manner.

· Initiates and schedules “second opinions” and Independent Medical Evaluations, as well as requests for referrals for “on-site” case management when deemed appropriate.

· Ability to appropriately utilize providers and resources to effectively manage the file based on workers’ compensation and/or NJ Auto Pre-Cert Guidelines.

· Maintain contact with patient in order to monitor compliance with physician’s directives, therapy, and work restrictions (in the case of workers’ compensation).

EDUCATION, EXPERIENCE, SKILLS

· Licensed nurse with a minimum of 2 years full time equivalent of direct clinical care to the consumer, preferably in rehabilitative services and/or certification as a case management specialist.

· Knowledge of discharge planning, utilization review, insurance systems, quality assurance and treatment protocols.

· Spanish speaking, preferred

· Accurate record keeping skills.

· Excellent time management and problem-solving skills.

· Computer proficiency.

· Must receive certification in case management within 4 years of working for FMCO

First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Nursing: 1 year (Preferred)
• Case management: 1 year (Preferred)

License/Certification:

• Nursing License (Preferred)

Work Location: In person