Nurse Case Manager

🕒 April 30

🦀 Maryland – Remote

🦀 Maryland – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Opus Medical

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

Opus Medical is a physician-led medical case management company that provides a high-touch, concierge approach to work-injury recovery for employers, payors, and injured workers. The firm delivers physician oversight, field and telephonic case management, RN record review, early medical assessments, life care planning, network support (including IME and peer review), and value-added services such as medical cost projection and Medicare set-asides. Opus emphasizes evidence-based care, faster return-to-work, lower total claim costs, and improved worker satisfaction through personalized clinical coordination and a technology-enabled system called Maestro.

📋 Description

• Performs initial history of injured worker via telephone interview. • Reviews injured worker’s records and enters the summary into the database including details of the injury, past medical history, physical exam, diagnosis, treatment, pertinent laboratory/ x-ray findings, medications, next follow-up appointment and any other relevant information. • Confers with the Medical Director, Supervisor or refers to Standing Orders on all new cases. • Confers with the Medical Director, Supervisor or Standing Orders on all proposed treatment plans, specialist referrals, surgery requests, treatment requests, or other decisions outside of licensure. • Coordinates specialist referrals with injured worker, employer, Specialist and adjuster. Documents Reimbursement Agreements on Authorization Letters for all Specialists who have a signed Provider Service Agreement on file with and forwards a copy to the adjuster. • Ensures contact with the injured worker after any appointment or procedure to determine medical status and/or outcome. Demonstrate progress on every case assigned at least every 30 days. • Ensures any medical reports are forwarded to all responsible parties. • Requests medical records from all sources which the injured worker has been treated for the injury/condition. Requests signed HIPAA from adjuster and sends with Medical Records request to all prior medical providers. • Answers questions and provides directions to injured workers regarding medical treatment within scope of licensure.

🎯 Requirements

• Completion of nursing school program and continuing education requirements to maintain certification • Must be licensed in state where case management services are provided. • Practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline • Prior experience in patient navigation, care coordination, case management. • Two years full-time equivalent providing direct case management to the injured worker or work under a supervisor for two years preferred

🏖️ Benefits

• Competitive pay and bonus program • Health, dental, vision, and retirement plans • Flexible scheduling • Nurse referral program • Continuing education support