Case Management Specialist

Title: Case Management Specialist
Location: Lake Mary, FL 32746
Fulltime

 
We are looking for a RN Case Manager to be permanent employee onsite at the Miami Airport. The candidate needs to be bilingual and have Worker's Compensation experience. 
 
TCM Specialist Needed Some field work will be required (visiting doctor’s offices etc). Will need to be able to work in Miami Airport. Needs W/C Experience and will be working on the heavily litigated client, American Airlines. Must be Bilingual (Spanish). Union knowledge would be very helpful. Will only need FL jurisdiction
 
PRIMARY PURPOSE: 
 
To perform initial and ongoing clinical assessment and evaluate need for alternative treatment, to negotiate and coordinate appropriate medical treatment and length of disability with providers and employers; and to implement a case management plan with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
 
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
 
Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client’s situation for psychosocial needs, cultural implications and support systems in place.
Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
Evaluates need for alternative treatment.
Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
Negotiates and coordinates a prompt return to work with employer.
Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data.
Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor.
Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
 
ADDITIONAL FUNCTIONS AND RESPONSIBILITIES:
 
Performs other duties as assigned.
Supports the organization's quality program(s).
 
LICENSING:
 
Current unrestricted RN license(s) in a state or territory of the United States required.
Certification in case management, rehabilitation nursing or a related specialty is highly preferred.
 
EDUCATION:
 
Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
 
EXPERIENCE:
 
Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of fulltime equivalent providing direct clinical care to the consumer.
 
SKILLS & KNOWLEDGE:
 
Knowledge of workers' compensation laws and regulations
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
 
WORK ENVIRONMENT:
 
When applicable and appropriate, consideration will be given to reasonable accommodations.
 
Mental:
 
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
 
Physical: Computer keyboarding, travel as required
 
Auditory/Visual: Hearing, vision and talking
 
NOTE:
 
Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

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