Telephonic Nurse Case Manager

ATHENS POSITION DETAILS

Position Title: Telephonic Nurse Case Manager

Department: Managed Care

Reports To: Case Management Supervisor

FLSA Status: Exempt

Job Grade: 14

ATHENS ADMINISTRATORS

Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!

Position Summary

Athens Administrators has an immediate need for a full-time Telephonic Nurse Case Manager to support our Managed Care Department. The position can be located remotely from California, Nevada, Texas, Oregon, Idaho, Arizona, or Oklahoma if technical requirements are met. This position will work M-F from 9am to 5pm PST schedule regardless of time zone. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. The Telephonic Nurse Case Manager researches and recommends resources and creates flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate. This position will assist the unit in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training.

Primary Responsibilities

Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:

• Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties.
• Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services.
• Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations).
• Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
• Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
• Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved.
• Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports.
• Develops Independent Medical Evaluation Plan. Provides assessment, planning, implementation, and evaluation of patient's progress
• Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed.
• Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim. Work with the treating physician to update any conditions as medical treatment progresses
• Assesses the injured worker and his/her support system and family. Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
• Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment, ensuring the job is consistent with any physical restrictions assigned by the treating doctor.
• Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force.
• Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan.
• Research medical and community resources for patients with catastrophic or chronic diagnoses, such as but not limited to, AIDS, cancer, spinal cord injury, diabetes, head injury, back injury, hand injury, burns, et cetera.
• Maintains constant contact with the adjuster assigned to the file through telephone calls, email, and written reports.
• For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer.
• Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers’ compensation and federal laws that impact the delivery of health care and return to work
• May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
• Assist the overall unit with development of workflows, best practices, reporting templates, and training needs as deemed necessary.
• Requires regular and consistent attendance
• May be asked to travel to other branches for training or file reviews as needed.
• Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
  
  

Essential Position Requirements

The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.

• A Master's or Bachelor's degree in nursing or an Associate's Degree in Nursing from an accredited school, along with equivalent work experience, is required
• CCM, CIRS, CRRN, COHN or other related designation preferred
• Master’s or Bachelor’s degree in related field with a CCM, CDMS, or CRC or other related designation preferred
• Active RN license from any US state required at time of hire
• Current RN licensure in CA required within one year of hire (if not already obtained)
• California RN application submitted within the first two weeks of hire. Athens reimburses licensing fees
• 3+ years’ workers’ compensation case management experience or related field required
• Strong clinical background in orthopedics, neurology, or rehabilitation useful
• Strong cost containment background, such as utilization review or managed care also useful
• Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc.
• Strong negotiation skills
• The ability to work effectively with minimal direct supervision
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly, accurately and for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
  

APPLY WITH US

We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings. Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.

This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.

Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

THANK YOU!

We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!

Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here