ABOUT THE POSITION
POSITION: LVN/LPN Workers’ Compensation Medical Case Management Nurse (aka Nurse Case Manager)
REPORTS TO: Director of Medical Management and/or Designees
LOCATION: This position may require employees to visit the office, field assignments, presentations, trainings, or other professional events on a schedule or on occasion. This position will be primarily remote. Only California residents in the Inland Empire or East San Diego County with a valid and unrestricted California LVN/LPN license will be considered for this position.
HOURS: Monday through Friday, normal business hours, 8 hours per day. Some overtime may be required.
PRINCIPAL ACCOUNTABILITY
The Medical Management Nurse (aka Nurse Case Manager) is the medical liaison for Workers' Compensation claims administrators, employees, employers, and healthcare providers. The Nurse Case Manager functions as an advocate for timely, appropriate medical care in the Workers' Compensation system by coordinating treatment and other services, communicating with all relevant parties, educating and maintaining working relationships with injured workers and their families, implementing efficient claim strategies, and using their nursing knowledge and judgment to effectively manage the medical care of injured workers on behalf of their employers.
This position requires the exercise of professional judgment, the application of medical knowledge and training, clear and accurate communication, and the implementation of criteria and procedures to facilitate effective, timely, and appropriate medical treatment for Workers’ Compensation claims.
ESSENTIAL DUTIES
- Refer to and apply medical knowledge, training, guidelines, criteria, and nursing ethics in performance of all job duties
- Effectively and responsibly manage a caseload of 50-80 telephonic and/or field cases, depending on type of claim and type of services required
- Communicate accurately, timely, professionally, appropriately, and comprehensively with injured workers, claims adjusters, attorneys, employers, providers, clinics, and other parties with information relevant to a claim, via phone, email, U.S. mail, fax, virtual meeting, or other platform
- Coordinate timely and appropriate medical treatment and related services for workers' compensation injuries and illnesses
- Obtain, create, review, analyze, organize, transmit, and maintain all appropriate documentation on assigned claims
- Adhere to department, company, regulatory, medical, ethical, and all other relevant standards and guidelines in execution of duties
- Educate and obtain information from injured workers and their families/caretakers relevant to their injury, treatment, and other circumstances relevant to their employment
- Create, review, and implement appropriate and effective treatment plans in cooperation with appropriate parties
- Prepare and send appropriate letters to interested parties
- Prepare documentation and case summaries for internal and external purposes
- Understand and utilize appropriate medical treatment guidelines (e.g., ACOEM, ODG, etc.)
- Understand and utilize HCO and MPN regulations as they pertain to NCM services and treatment
- Explain relevant MEDEX services clearly to interested parties, such as injured workers and claims professionals
- Review and research applicable networks to locate appropriate care
- Coordinate authorization for medical treatment and/or perform workers' compensation utilization review services within the scope of a non-physician reviewer, in cooperation with claims administrator
- Coordinate return-to-work and modified duty activities and create or obtain appropriate documentation
- Utilize preferred vendors as determined by claims administrator
- Manage cases appropriately for type of claim (medical-only, indemnity, etc.), type of injury, location, employee type, employer instructions, etc.
- Maintain timely communications with medical providers
- Act as resource to claimants regarding their medical treatment
- Identify opportunities for Transfer of Care to an MPN
- Act as an HCO and MPN resource for claims
- Assess employee function before, during, and after return-to-work
- Respond to letters of representation with appropriate documentation
- Respond to self-procured physicians with appropriate documentation
- Maintain and protect the confidentiality of all protected health information and other confidential or proprietary information
- Follow and record compliance with standard operating procedures, regulations, laws, and other instructions
- Participate in audits, accreditation activities, and other quality assurance functions
- Prepare for and professionally participate in meetings, trainings, presentations, observations, workshops, conferences, and other activities
- Support and cooperate with other units and departments
- Perform other related duties as assigned
PHYSICAL ACTIVITY
- Requires extended periods of sitting, phone work, and data entry
- Ability to travel to attend occasional events such as conferences, trainings, and field nurse case management assignments
- Lifting up to 20 pounds, including receiving delivery of and setup of remote work equipment such as monitors, computers, and other hardware
REQUIRED QUALIFICATIONS
- Valid and unrestricted California LVN/LPN license
- Fluent in English and Spanish
- Proficiency in Microsoft Office 365, keyboarding, EMRs, CMSs, cloud-based databases, and other computer-based programs essential to efficient remote work
- Effective and professional oral and written communication skills
- Ability to work independently, analyze medical information and arrive at sound clinical decisions related to continuing medical treatment
- Demonstrated experience collaborating and communicating with physicians
- Must be able to handle sensitive and confidential information with the highest degree of professionalism
- Outstanding organizational and time management skills
- Capable of multitasking and meeting deadlines
- Ability to work with extended periods of sitting, phone work, and data entry
- Ability and resources to work remotely, including private high-speed internet with enough available bandwidth for work purposes, reliable cell phone or landline access, secure, private, and ergonomic work space
- Ability and resources to travel within the U.S. for work-related meetings, events, conferences, presentations
- Access to a reliable private vehicle and authorization to drive within the employee's geographic area (up to 50 miles one-way) for occasional or regular field case management assignments (mileage reimbursed)
PREFERRED QUALIFICATIONS
- Valid and unrestricted compact state LVN/LPN license (in addition to California license)
- 3+ years of experience in Workers’ Compensation, medical case management/nurse case management, or UR/UM
- Multilingual
- Supervisory or other leadership experience in professional settings
- 5+ years in clinical settings
- 5+ years in occupational health
- Case Management certification or other relevant certifications
ABOUT MEDEX
MEDEX is based in Irvine, California, and we’re continuing a sustainable trajectory of growth since our founding in 1996. Serving some of the nation's largest and most recognizable companies, we strive to be the simple, strategic, and smart solution to our clients' Workers' Compensation woes.
Our success comes from providing employers with a secret weapon to battle the inefficient costs of Workers' Compensation claims in California. Our HCO+MPN provider networks are the most unique and powerful medical cost control tool in the industry. Supporting our boutique networks are our industry-leading Managed Care and Medical Management services. At MEDEX, we're proud to have a wide range of professionals on staff, including physicians, customer service specialists, nurses, data analysts, attorneys, and other valuable experts.
According to a recent survey, 100% of responding MEDEX employees feel that they are doing meaningful work every day, feel positive coming to the office in the morning, and have an optimistic view about the company's future. MEDEX employees also rated the company 4.5 out of 5 stars as an employer. That's because we're in the sweet spot so many job seekers are looking for: small enough to have a family-like atmosphere but large enough to have the resources to provide employees with great benefits and opportunities for growth.
We are always excited to welcome knowledgeable, committed, and engaged new members to the team!
Job Type: Full-time
Pay: $22.00 - $28.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid sick time
- Paid time off
- Vision insurance
Standard shift:
Supplemental pay types:
Weekly schedule:
Ability to commute/relocate:
- Inland Empire, CA: Reliably commute or planning to relocate before starting work (Required)
Experience:
- Nursing: 1 year (Preferred)
Language:
License/Certification:
- California LVN/LPN license (Required)
Work Location: In person