Medical Case Manager

Job Summary

• The Medical Case Manager (MCM) is a Registered Nurse and may also be referenced as the Nurse Case Manager (NCM).

• The MCM implements integrated medical disability case management services with the goal of preventing, minimizing, or overcoming disability.

• The MCM provides medical expertise and serves as the critical communication link between the parties involved in any medical disability case.

• The MCM emphasizes returning medically-able individuals to productive service.

• The MCM ensures timely interventions and facilitates continuous communication while providing patient advocacy through supporting patient choices.

• As a Registered Nurse, the MCM, provides a professional nursing approach to case management through the Nursing Process involving: Assessment, Planning, Implementation, Monitoring, and Evaluation.

• The MCM is sensitive to the importance of productive work and sees a return to work as the key outcome.

• Responsible for coordinating the treatment pathways of those claims that meet the internal case management criteria, including setting the treatment plan and other activities that meet an injured worker's/employee's health and return-to-work needs or other productive activity.

• Understands and implements criteria for identifying individuals for case management services

• Coordinates case management plans and activities with the human resources department of the injured worker/employee

• Solicits the employee's interest and consent, if necessary, for participation in case management activities and documents oral and/or written consent

• Documents a case management plan specific to the injured worker/employee that includes short- and long-term goals with timeframes, timeframes for re-evaluation, resources to be utilized, and collaborative approaches to be used (including physician participation)

• Conducts and documents an assessment of each injured worker/employee including (as appropriate) health status, treatment plan, financial resources for health care, psychosocial status, consumer knowledge, education needs in relation to health status and treatment plan, past relevant history, and possible non-medical impediments to successful resolution

• Responsible for managing the disability duration of an injured worker/employee and focus on return-to-work opportunities or other productive activity, including working with medical providers to identify an estimated return to modified duty, vocational rehabilitation, release from care, or actual return-to-work date

• Collaborates and clearly communicates with the injured worker/employee, family members, providers, employer, or the employer's representative in the execution of a plan for return-to-work or other productive activity.

• Identifies and obtains any required or outstanding medical documentation in support of the individual's plan for a return-to-work or other productive activity.

• Understands and implements criteria for discharge of injured worker/employee or termination of case management services

• Promotes goodwill by assisting all involved parties on issues related to the injured worker/employee, provider relations, and OWCP coordination, as applicable.

• Identifies, evaluates, and recommends strategies for claims where vocational rehabilitation services may produce an eventual return-to-work, interfaces with vocational rehabilitation or other specialties as appropriate and applicable.

• Understands the organization's quality management program and the case manager's role within that program

• Is an effective team member; supports the team by pitching in at any level and effectively working across the organization to meet the needs of the business

• Takes ownership of personal actions and outcomes; encourages and empowers others to do the same

• Embraces change; maintains an open mind and is flexible and adaptable in the face of ambiguity and change

• Ability to work independently, multitask, and adjust priorities

• Proactively seeks opportunities to increase knowledge, skills and abilities

• May perform other duties, as needed, to meet the needs of the business

• May lift, carry, push, and/or pull objects weighing up to 10 lbs. Occasionally but rarely may move objects weighing up to 20 lbs.

• Coordination and Service Delivery

• Community Resources

• Access and evaluate available resources and develop additional resources as the need arises

• Maintain relationship with WTC-NPN team, including representatives of claims, call center, and network

Requirements:

• Able to work under time constraints and deadlines.

• Must have strong communication and organizational skills, and an ability to interact and work with others.

• Experience with Federal Employee Compensation Act (FECA) and FECA related issues preferable, as applicable for assigned account(s).

• Bachelors in Science Nursing or Associate in Nursing (ASN) or Nursing Diploma.

• An active RN license in the state they live in

• National certification in case management or related field preferred.

• MUST HAVE Unrestricted Current Massachusetts and Compact State Registered Nurse License

• 3+ years of clinical experience as a Registered Nurse

• 2+ years experience in medical case management, discharge planning, utilization review/management to determine the necessity of medical services, occupational health, and/or comparable field

• Experience in Behavioral Health Chronic Medical Conditions or Oncology preferred,

• Superior customer service skills working proactively and collaboratively with client colleagues and client leaders, medical staff, and co-workers.

• Ability to effectively present information.

• Excellent team player; ability to partner with internal and external clients and other cross-functional departments.

• Superior writing skills.

• Must write succinctly and clearly and explain complex situations in plain English to technical and non-technical audiences.

• Utilizes direct communication and proactive problem solving to address challenges and disagreements.

• Reasoning Ability: Ability to apply logical thinking to a wide range of intellectual and practical problems.

• Able to deal with very difficult concepts and complex variables.

• Ability to comprehend, analyze, and interpret documents.

• Ability to solve problems involving several options in situations.

• Requires intermediate analytical and quantitative skills.

• Proficiency in Microsoft Office and Computer proficiency

• Appreciate and comply with all confidentiality requirements

• Be proficient in how to obtain and document an accurate medical history

• Be skilled in developing treatment plans with realistic goals

• Understand information systems and data management

• Physical and Psychological Factors

• Understand the physical and psychological characteristics of illness and be familiar with methods for assessing an individual's level of impairment

• Be capable of assisting individuals with the development of short- and long-term goals for recovery

• Case Management Concepts

• Be educated in current protocols and procedures for case management related to the WTC-NPN environment

• Have an understanding and appreciation for nationally recognized standards of the case management process, particularly in regard to long-term medical conditions

Benefits:

Healthcare Insurance: Synectics offers eligible employees and their dependents healthcare coverage through BlueCross BlueShield of Illinois. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics. Premiums are subsidized by Synectics.

Dental Insurance: Synectics offers eligible employees and their dependents a dental plan through MetLife. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.

Vision Insurance : Synectics offers eligible employees vision insurance through VSP. Eligibility begins on the 1st day of the calendar month following 60 days of continuous full time employment with Synectics.401(k) Plan: The Synectics Inc. Investment Savings Retirement Plan. Synectics offers all employees who are 21 years of age or older the opportunity to invest in the 401(k) Plan on the first enrollment date that is at least 30 days after employment begins. Enrollment dates are each January 1st, April 1st, July 1st, and October 1st.

Technical Certification Bonus: Synectics is pleased to award its employees a bonus of up to $500 for an approved professional certification. In determining the bonus amount, Synectics will consider the cost of the test(s) for any certification relating to your current position, achieved during your employment with us. Only one Certification Bonus per calendar year may be awarded per employee. Only current, active employees will be eligible to receive this bonus. It will be awarded 90 days after the Synectics office has received documentation confirming the successful completion of the certification.

Synectics is an equal opportunity employer.