Remote Nurse Case Manager: Healthcare/Disability Claims – RN – MI, TX, MN, IL
- Clinical License RN
- State(s) IL, MI, MN, TX
Full job description
We are searching for a new RN to join our team. Our Nurses enjoy the flexibility to work remotely and do not have face-to-face Patient contact. This position is performed in a home-office environment and requires great telephonic/customer service and documentation skills in addition to clinical experience. Please review the roles and responsibilities of this position below. Please complete all application questions and follow-up assessments. Incomplete applications will not be accepted.
The Disability Nurse Case Manager (DNCM) is responsible for the oversight and completion of assigned disability claims for the purposes of making appropriate clinical decisions with the appropriate use of applicable sources.
Role and Responsibilities
· A thorough and comprehensive review of disability applications to determine:
o Identification of conditions eligible for disability review
o The existence, nature and severity of the disability condition(s)
o The compilation of applicable information through outreach to providers, disability applicants, employers, and other applicable parties
o Need for MAs in an appropriate clinical setting.
o Review and analysis of all information directly or indirectly related to the disability application and/or that information obtained during the triage process.
o Recommendation of disability status.
· As a primary function, perform outreach to the medical provider(s), disability applicant, and/or employer and other necessary parties to gather additional information and/or clarify information for the purpose of assisting in the decision-making process of the DCR process.
· Identify need for a Medical Assessment
o Choose appropriate type of MA to be performed.
o Request appropriate physician specialty based on both the clinical and functional aspects of the case.
o Properly submit and track MA referral.
o Communicate with the Medical Assessment Specialist and external vendor staff to monitor/track/trend MA activities.
· Determine receipt of necessary and complete information with which to sufficiently perform the triage function.
· Determine case-specific Periodic Review schedules for appropriate follow-up, as needed.
· Identify the need for a case to be escalated
· Prepare disability recommendations to be forwarded to client upon completion of required triage functions within required deadlines.
· Ensure workflow diagrams are followed and that status activity fields within the respective triage levels are accurately entered into the system within the time constraints set forth by client.
· Complete system generated tasks in regard to specific cases in the scheduled timeframes and update accordingly
· Ensure completeness and accuracy of all case paperwork and documents.
· Keep clients informed of case progress, as needed. (i.e. delays, etc.).
· Ensure timely and appropriate communication with clients on status of open or pending cases, as requested.
· Identify quality improvement opportunities.
· Committee participation, as appropriate.
Other duties, as deemed appropriate
Job Type: Full-time
Pay: $75,000.00 – $79,500.00 per year
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Monday to Friday
- Bachelor’s (Required)
- RN: 3 years (Required)
- Healthcare Claims/Disability/Workers Comp/Insurance: 2 years (Required)
- RN (Required)
- Day Shift (Required)
Work Location: Remote