Nurse Case Manager

  • Shreveport, LA
  • Full-time

Company Description

Hammerman & Gainer (HGI) is a Louisiana-based program management and third party administrator company.  For over 80 years, HGI has worked with insurance companies, corporations and governmental entities distinguishing ourselves from competitors by designing and implementing systems, processes and policies that meet the complex legal, regulatory, and administrative requirements of our clients.  Today, HGI's continued success is the direct result of matching our resources with our client’s needs in order to mitigate their exposure to risk and preserve their assets.  Our client list is as diverse as the markets we serve!

 

HGI’s corporate office is located in the greater New Orleans area, but with a national footprint of regional offices in Atlanta, Austin, Dallas, Los Angeles, and Washington D.C.  HGI is also licensed to provide healthcare administrative services in all 50 states and Washington D.C.

Job Description

Utilization Case Management best practices, nurse Assesses, plans, implements, coordinates, monitors and evaluates medical services, utilization review and return to work options for injured employees; Department resource for medical inquiries, claim file reviews and medical research. Bills 40 hours per week once caseload is established. The nurse Case Manager will work from home and cover the Shreveport Louisiana area.


PROVIDES MEDICAL AND OCCUPATIONAL MANAGEMENT ACTIVITIES FOR EMPLOYEES WITH WORK RELATED INJURIES AND PROVIDES EARLY RETURN TO WORK INTERVENTION FOR NEW INJURIES, CONSULTING ON MEDICAL ONLY AND LOST TIME CLAIM INJURY FILES. COORDINATES SECOND MEDICAL OPINIONS AND REHAB CONFERENCES.  


EVALUATES HEALTH CARE SERVICES OF REQUESTING PROVIDES BASED UPON THE APPROPRIATENESS OF AND LEVEL OF CARE AT WHICH THIS SERVICE WOULD BE DELIVERED. CREATES REPORTS AND DOCUMENTS ACTIVITIES PERFORMED ON EACH CASE ASSIGNED.

PERFORMS MEDICAL REVIEWS ON WORKERS' COMPENSATION CLAIMS AND PROVIDES RECOMMENDATIONS WHICH ARE PREEMPTIVE, FOCUSED ON MOVING THE INJURED EMPLOYEE ALONG THE HEALING CONTINUUM TO MAXIMUM MEDICAL IMPROVEMENT (MMI), RETURN TO WORK OPPORTUNITIES AND EMPLOYER PROTECTION. 


APPLIES CLINICAL EXPERTISE AS A RESOURCE TO THE CLAIM ADJUSTERS, EMPLOYEE, AND THE EMPLOYER TO IDENTIFY THE BEST RESULTS WHILE COORDINATING THE APPROPRIATE RESOURCE UTILIZATION; IDENTIFIES AND MANAGES PATIENT PROBLEMS TO ELIMINATE DUPLICATION AND FRAGMENTATION OF HEALTH CARE SERVICES. 


KEEPS ADJUSTERS UPDATED ON CLAIMS RELEVANT ACTIVITIES AND ACTS AS A LIAISON BETWEEN PROVIDER, INJURED WORKERS AND ALL OTHER RELEVANT PARTIES.

ASSIST IN DEVELOPMENT OF POLICIES AND PROCEDURES, STANDARDS OF CARE AND PRACTICE, AND IN THE MONITORING OF THOSE STANDARDS TO ENSURE REGULATORY COMPLIANCE, AS REQUIRED BY THE DIVISION OF WORKERS' COMPENSATION AND THE DEPARTMENT OF INSURANCE. 

MEET WITH MANAGER ON A REGULAR BASIS TO DISCUSS ASSIGNMENTS, BILLING AND CASE MANAGEMENT STRATEGIES.

USES VEHICLE TO ATTEND MEDICAL APPOINTMENTS, MEET WITH INJURED WORKERS AND/OR FAMILY MEMBERS/PROVIDERS TO COORDINATE SERVICES.

Qualifications

Registered Nurse or BSN, with 2 years case management or occupational health experience. CCM desired, but not required.

PREFERRED SKILLS

KNOWLEDGE OF: WORKERS' COMPENSATION CASE MANAGEMENT AND PRACTICES; MANAGED CARE AND OCCUPATIONAL HEALTH ISSUES AND STANDARDS; APPLICATION OF THE NURSING PROCESS; FULL RANGE OF REGISTERED NURSE DUTIES AND RESPONSIBILITIES; PRINCIPLES AND METHODS OF SUPERVISION AND TRAINING; BASIC MANAGEMENT SKILLS; PROBLEM SOLVING TECHNIQUE


Additional Information

All of your information will be kept confidential according to EEO guidelines.

Hammerman & Gainer, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability.


EEO is the Law. http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf


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