HEMIC seeks an experienced case manager with excellent communication, customer service, decision-making, time management and organizational skills. Must be pro-active, resourceful and diplomatic, possess discretion and solid judgment, work well in a team environment, and embrace HEMIC’s Best Practices and Service Standards. The ultimate goal of this position is to help injured workers successfully recover and return to productive capacity.
This role provides telephonic case management (TCM) services for workers’ compensation claims, including triage. The TCM will assess, evaluate, plan, implement, and oversee the treatment appropriateness for occupational injuries based on Official Disability Guidelines (ODG) and the Hawaii State Medical Fee Schedule (HSMFS), while actively coordinating early return-to-work (RTW) efforts. The TCM utilizes clinical knowledge, positive communication skills, problem solving, and conflict resolution techniques. The TCM engages the claimant, physician and claim specialist, working collaboratively in an effort to provide focused claim resolution and return-to-work driven outcomes.
- Provides telephonic nurse case management (TCM) – medical care coordination and facilitation of early return to work (RTW) in a workers compensation environment.
- In accordance with TCM Guidelines, make timely contacts, complete initial, status and closing reports, and document all information in Tropics Notebook. In accordance with clinical protocols, assess and document the treating physician’s initial and ongoing treatment plan for diagnosis, symptoms, history, diagnostic testing, medication, specialty referral, therapies, next appointment date, anticipated length of disability, physical status, and expected MMI.
- Conduct periodic task assignments (field) as deemed necessary and approved by Manager.
- Develop medical case management plans that ensure a balance of quality of care and cost-effectiveness while making recommendations that are specific, action-oriented and target-dated.
- Review medical reports and treatment plans, identify barriers to recovery and formulate a medical case management plan to overcome these barriers. Coordinate approved treatment when appropriate, as well as diagnostics, durable medical equipment, FCEs, and transportation.
- Address RTW capability with the injured worker and provider after each visit. Update the claim specialist once information obtained and document a brief summary in Guidewire claim system.
- Calculate and monitor the estimated length of disability and expected course of medical treatment based on Official Disability Guidelines (ODG), and communicate this to the claim specialist.
- Works with departmental colleagues in a “team concept” — sharing ideas, knowledge, expertise and experience. The team concept enhances the department’s overall knowledge and work quality.
Successful candidates will have:
- Valid RN or CCM license required. BSN preferred, but not required. ADN may apply.
- CCM, CDMS, CIRSC and/or COHN preferred.
- Current Hawaii state driver’s license.
- One to three years’ experience in nurse case management, preferably in areas of occupational medicine, rehabilitation, managed care, or acute hospital setting.
- Be able to maintain a caseload between 45-65.