Responsible for managing the medical care received by a claimant following an injury. The RN Case Manager monitors all treatment and acts as a liaison between the account, provider, and the claimant for returning the claimant to health and/or work in an appropriate amount of time based on disability guidelines and physician assessment) and is responsible to coordinate care with quality and cost effective outcomes.The RN Case Manager will be work out of their home office and will travel frequently to and from appointments, within a 2-hour radius, across Northern New Jersey (including Newark, Fairlawn and Morristown) for Field Based Case Management. Responsibilities will also include Medical Bill Auditing.Primary Responsibilities:Implements and acknowledges all new referral contacts to account, claimant and physician within same business dayMonitors all treatment and acts as a liaison between the account, provider, and the claimantArranges and attends all medical evaluations, physician appointments and physical therapy when needed, including those that may occur before and after regular business hours, or on occasional weekends, and holidays in the event of catastrophic casesCases are assigned with geographic location taken into consideration, but territory may extend beyond a given location and cross state lines in some instances, depending upon needParticipates in coverage as needed for other team members and co-workers as able/requested by supervisorCoordinates Independent Medical Examinations, as well as provider appointmentsParticipates in coordination of services for catastrophic cases to include, but not limited to, immediate visitation at Hospital to secure all accident and treatment information, coordination of discharge and home care needsArranges transportation services when necessary and authorizedReviews and evaluates all medical correspondence obtained from providersCoordinates and monitors home health care as necessaryImplements and utilizes community resources when applicableCoordinates case management reviews with the Case Management Supervisor on all filesProvides medical testimony as requiredHolds to the philosophy and standards of quality as outlined by Optum Management IncContacts accounts for directives and provides updates on file status. Completes written correspondence completed after each visit or every 30 days according to account profileInputs service notes on all tasks utilizing the RMS systemPrepares all letters and reports and emails to office for formatting and mailingUpdates accounts via emails and phoneSecures ongoing medical records and handles as confidential informationCompletes job descriptions; observes job site and completes job analysesCompares and coordinates medical costs; analyses benefit outcomes and documents savingsEnsures confidentiality and maintains accurate record keepingMaintains all educational requirements to renew and maintain licensure and certificationMaintains professional education in the area of rehabilitation and case management as well as current medical trendsCoordinates and attends all scheduled team meetings with all providers when necessaryUtilizes effective oral, written and organization skills and demonstrates the ability to prioritize case activitiesUtilizes personal vehicle to travel to job sites, claimant homes, attorney offices and medical facilities as necessary to perform visitsPerforms other case management duties as requiredCoordinates specialty services as authorized and needed by the accountMaintains the highest level of customer / client confidentiality and customer serviceMedical Bill Auditing to include but not limited to the following:Completes preliminary review of file to assure that all records are presentCompletes audit of itemized bill to assure that all charges are documented, related and medically necessaryWhere applicable completes trauma review to assure that trauma classification appliesReports findings in the audit reportCompletes audits within State specified timeframesRequired Qualifications:Current, unrestricted RN license in New Jersey1 years nursing case management and/or recent experience including any of the following settings: visiting nurse, med-surg, critical care, or emergency room2 years of full-time equivalent experience providing direct clinical care to the consumerMust have access to reliable transportation that will enable you to visit customer or patient sites within a 2 hour radius of the designated areaProficient computer skills including typing and Microsoft Office softwarePreferred Qualifications:CCM certificationPrevious Worker's Compensation Case Management experienceField-Based case management experienceCurrent, unrestricted RN licenses in New YorkPrevious experience working with managed careExperience with disability claimsExperience doing Medical Bill AuditingBachelor's degree or higherCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Associated topics: cardiothoracic, intensive, intensive care, maternal, psychatric, recovery, registed, tcu, transitional, unit