Job Summary

Come join the EK Health Family!

We're looking for a Telephonic Case Manager (California RN License required) to provide telephonic medical case management for our Worker's Compensation and Liability Injury Management programs. This includes assessing, planning, implementing, coordinating, and evaluation of service options. The goal of the Case Manager is to assist the injured worker in receiving appropriate, cost effective medical care for their injury in a timely manner, and to expedite their return to work.

Completing referrals within computer database from either injury report or information gathered from the web-based system
o Performs 3-point contact on new files and, depending on account, forwards within 24 or 72 hours from date of referral
o Reviewing and evaluating all medical correspondence and provider reports obtained to determine work status of IWs or patients
o Reviewing treatment plan history and direction of file with client, when necessary
o Providing a 24-hour update after all significant activity
o Evaluating clinical status of claimant and researches for alternative options to treatment as warranted
o Communicating with the claim's examiners regarding directives, and provides updates on file status
o Arranging transportation services when necessary and authorized
o Evaluating therapy facilities and their progress on specific cases
o Preparing comprehensive notes following any discussions had with IW, medical providers, claims examiners, and employers in the case file in EK TCM Ahshay and client system, per policy standards and procedure
o Completes initial reports every 14 days and every 30 days thereafter, according to account profile and service type.
o Ability to handle a variable case load dependent on service and client type
Utilizes the nursing process in conjunction with URAC standards, EK Standards and client guidelines to manage and move files forward.
o Assessment:
Perform a complete nursing evaluation
Collect relevant data to the patient's physical and mental status, functional capability, personal and environmental factors
Analyze the collected data to determine problems, strengths and needs of the patient
o Planning:
Discuss the analyzed data and the comprehensive plan of care with the insurance representative prior to implementation
Upon authorization, implement this plan of care with patient, physician and health care providers
o Implementation:
Make regular personal contact to oversee the contracted services in order to maintain quality of care
Arrange for care/services as needed (home care, procedures, medication, equipment or supplies)
Monitor the plan of care with modifications or changes suggested to the patient and physician as the need arises
Coordinate information between all parties (injured worker, physicians, employer, other providers, such as therapists, and attorney, if any is involved)
o Evaluation:
Determine the progress and the effectiveness of the care
Prepare a monthly report of the patient's progress and specific cost savings
Evaluating clinical files ongoing and ensuring care is medically necessary

This is a full-time position with benefits.