PRIMARY FUNCTION

· Manage the workers compensation claim appropriately and aggressively via professional communication with the physician, employer, employee, and insurer to expedite an early return to work and medical discharge.

RESPONSIBILITIES

· Perform initial assessment including history of injury, ongoing treatment, social, vocational and past medical history obtained from all relevant sources. Assessment may also include lifetime cost projections, as well as treatment plan recommendations.

· Develop and implement optimal rehabilitation plans including medical, psychological, social and environmental needs, compliance to treatment plans, monitoring progress and evaluating outcomes, and arranging funding through the insurance company for treatment, equipment or other rehabilitative activities.

· Coordinate rehabilitative services applied in multiple environments such as home care, transportation, community resources, equipment, therapies, independent consultations, discharge plans and facility admissions/discharge, across a continuum of care until optimal health is reached.

· Provide physician with employer light duty policy and job descriptions when appropriate.

· Implement effective negotiations and cost savings policies with regards to the above activities.

· Interact effectively with individuals, agencies and facilities involved in the individual’s recovery.

· Maintain case notes with appropriate information in a neat and organized manner.

· Initiates and schedules “second opinions” and Independent Medical Evaluations, as well as requests for referrals for “on-site” case management when deemed appropriate.

· Ability to appropriately utilize providers and resources to effectively manage the file.

· Maintain weekly contact with employee in order to monitor compliance with physician’s directives, therapy, and work restrictions.

EDUCATION, EXPERIENCE, SKILLS

· Licensed nurse with a minimum of 2 years full time equivalent of direct clinical care to the consumer, preferably in rehabilitative services and/or certification as a case management specialist.

· Knowledge of discharge planning, utilization review, insurance systems, quality assurance and treatment protocols.

· Accurate record keeping skills.

· Excellent time management and problem-solving skills.

· Computer proficiency.

· Bilingual (English and Spanish) required.

The salary range for this position is starting at $55,000 and may vary based on factors such as relevant experience, education, skills, internal equity, and market considerations. Final compensation will be determined during the interview process and in alignment with applicable law.

First Managed Care Option, Inc., is an Equal Opportunity Employer and takes pride in maintaining a diverse environment. We do not discriminate in recruitment, hiring, training, promotion or any other employment practices for reasons of race, color, religion, gender, national origin, age, sexual orientation, marital or veteran status, disability, or any other legally protected status.

First Managed Care Opti

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