RN, Telephonic Clinical Case Manager

🔥 14 minutes ago

🐊 Florida, Illinois, +3 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🤠 Texas – Remote

💵 $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Managed Medical Review Organization, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2007

🏥 Healthcare

🏛️ Government

💼 Consulting

Healthcare • Government • Consulting

Managed Medical Review Organization, Inc. is a national leader in disability and medical review services. MMRO provides independent medical review, evaluation services, vocational assessment, disability case management, disability claims and peer review, and health care review for public- and private-sector clients including disability carriers, government agencies, employers, and group health plans. The company develops and implements customized clinical and operational solutions tailored to each client's requirements.

📋 Description

• Determine the appropriate case management track for each assigned case. • Conduct telephonic clinical assessments covering activities of daily living, psycho-social factors, recent hospitalizations, current clinical status, treatment plans and medications, treating physicians, special needs, and the appropriate outreach interval for each case. • Develop customized, member-specific clinical case management plans. • Perform ongoing periodic telephonic outreach at intervals set during the initial clinical assessment. • Request and track receipt of the records and documentation needed to identify ongoing case management needs. • Build and maintain a case management resource library to provide members with information relevant to their conditions. • Assess whether a review is needed for a member's return to their own occupation, and identify the appropriate physician specialty when it is. • Collaborate with vocational specialists during the case management process when needed. • Conduct thorough, ongoing quality review of all case documentation and ensure completeness and accuracy of case paperwork. • Communicate with members, physicians, employers, and clients as appropriate. • Enter case activities into the case management system accurately and within client-required timeframes. • Maintain compliance with applicable practice standards and guidelines, including strict confidentiality and HIPAA adherence.

🎯 Requirements

• Unrestricted RN licensure, without sanctions. • Current certification in case management or a related field, or the ability to qualify for certification testing within six months of hire. • Minimum of five years of clinical experience. • Minimum of five years of case management experience in one or more of the following: medical, workers' compensation, auto, or disability case management. • Working knowledge of diagnostic coding (ICD-10). • Strong critical thinking, decision-making, and organizational skills with close attention to detail. • Ability to meet deadlines and turnaround times consistently. • Ability to work independently as well as within a team. • Computer literacy, including solid working knowledge of Microsoft Word and Excel. • Strong written, verbal, and telephonic communication skills, with the ability to manage multiple priorities. • Bachelor's degree in nursing or a health-related field. • Working knowledge of the insurance industry, medical claims, and/or disability claims. • Experience with Lean production management.