Bilingual Field Case Manager

Baltimore, MD - Baltimore, MD

• Salary Range: $80,000.00 - $90,000.00 Salary
• Position Type: Full Time
• Job Shift: Day
• Travel Percentage: Road Warrior

Preferred:

• A company approved certification is preferred and strongly encouraged.

Summary: Performs case management duties/services of a confidential nature and adheres to essential activities defined by the Commission for Case Management. This position’s primary duty is case management which requires advanced knowledge in the medical field and is predominantly intellectual and varied in character. Professional Registered Nurse Case Managers must consistently use their discretion and judgement in applying the advanced knowledge of their field to the management of their cases and the performance of their day-to-day tasks. This position must complete productivity hours, based on work days/month. Additional production hours may be required to achieve ACM goals. Supervision of all plans and plan assessment is an ongoing process between Professional Registered Nurse Case Managers, Director of CM Services, the Chief Operations Officer, VP of Case Management Services and the ACM President to ensure optimal plan effectiveness, goal achievement, and customer satisfaction with ACM’s case management services. The effectiveness of the plan and plan goals will be evaluated and documented every 30 days. The Professional Registered Nurse Case Manager must be cognizant of the continuum of care and the case management process and use discretion and judgement to determine if it matches a consumer’s needs in areas of health, medical care appropriateness, and financial, legal, and psychosocial care.

Responsibilities:

• Use discretion, judgment, and advanced knowledge in the medical field to:

• Assess Injured Worker’s traumatic injuries/illnesses.
• Assess Injured Worker’s functionality.
• Identify needs to develop a comprehensive case management plan defining those needs.

• Interact, communicate with, and gather information from injured worker and injured worker’s:

• Family.
• Physicians.
• Employers.
• Professional and non-professional care givers.
• In addition, gather medical records, educational records, claim information, and military information from all the above sources.

• Interact with the consumer’s health care system which includes:

• Physicians.
• Family members.
• Insurance payers.
• Employers.
• Ancillary healthcare providers.

• Use discretion and judgement to determine specific objectives, goals, and actions to meet injured worker’s needs identified through assessment process.
• Document the necessary actions/time frames to accomplish objectives, goals, and actions.
• Repeatedly evaluate case management plan at appropriate intervals.
• Exercise discretion and judgement to determine if case management plan is effective, reaching desired goals for the consumer.
• Make modifications and changes to case management plan when necessary to ensure goal achievement.
• Must not devote any time to activities that are not an essential part of and necessarily incident to exempt work.
• Other duties as assigned.

Additional Responsibilities Include:

• Follow appropriate customer billing procedures for customer billing review. This includes the documentation of any prolonged travel billing such as:

• Traffic.
• Construction.
• Weather.
• Other delays beyond the Professional Registered Nurse Case Manager’s control.

• Meet all quality standards of ACM customers.
• Meet quality expectations of ACM customers regarding billing timeliness and accuracy of reporting.

• Participate in team meetings to discuss:

• Individual case management plans.
• Development of new customers.
• Other business development strategies.

• Participate in ongoing educational sessions to maintain/increase skill level and advanced knowledge in the medical field. All ongoing educational participation requiring a fee must first be approved by the ACM President, VP of Case Management Services or Director of CM Services.
• Attend annual company-wide education seminar or, if unable to attend, plan to obtain via written or electronic means.
• Must not devote more than 20% of time to activities that are not closely related to exempt work.
• Other duties as assigned.

Qualifications

Advanced Knowledge Educational/Licensing Requirements:

Required:

• Graduate from an NLN approved RN Program.
• Possesses and maintains current, valid, unrestricted RN license verified by the appropriate State examining board per ACM policy. A compact RN license may be required when indicated.
• Maintains any additional State RN licensure required by the President.
• Two years of providing direct clinical care as a Registered Nurse is required.
• Additional licenses and certifications, such as a WCCM, may be required based on the operational requirements of specific geographical locations.
• The ACM President reserves the option to modify any or all requirements based on geographic area and company need.

Needed Attributes:

• This position requires excellent communication skills, organizational skills, astute independent decision making abilities, idea formation, and planning skills.
• The Professional Registered Nurse Case Manager must be a self-starter and be able to work independently from a remote office.

Physical Demands/Essential Functions (With or Without Reasonable Accommodation):

• Must be capable of driving unlimited distances during a workday. This will likely involve continuous driving of 2 hours one way.
• Due to driving requirements associated with the job, this position is considered safety sensitive.
• Must be able to walk on all ground/pavement surfaces, including uneven surfaces.
• Walking may include extended distances in parking lots and negotiating stairs.
• Extensive standing and sitting may be required.
• Ability to deal effectively with stress.
• Fine motor dexterity for operation of smart phone, laptop, desktop, and/or tablet.
• Visual acuity for close and distant vision and ability to adjust focus.

Miscellaneous Job Requirements:

• This position works from home with potentially over 80% travel.
• Must have a dedicated workspace that allows compliance with HIPPA and PHI data.
• Must use computer and maintain internet connectivity, either wired or wireless, that allows communication with laptop/desktop, printer, and fax.
• Maintain current Driver’s License in the employee’s State of residence.
• Maintain valid vehicle insurance.
• Employee may occasionally be required to work evenings or weekends to meet quality reporting deadlines.
• CM must be available during normal work hours of 8am-4:30pm, Monday-Friday. Additional hours before and after these normal hours may be needed to accommodate travel to and from appointments. Occasional evening and weekend hours may be needed to meet the business needs of the company.