Nurse Case Manager Job Description
Nurse case manager
provides education and information to physicians and hospital staff regarding case management/utilization review, third party reimbursements and ways to improve reimbursement.
Nurse Case Manager Duties & Responsibilities
To write an effective nurse case manager job description, begin by listing detailed duties, responsibilities and expectations. We have included nurse case manager job description templates that you can modify and use.
Sample responsibilities for this position include:
Acts as an advocate for injured/ill individuals through the assessment, planning, coordination, collaborating, evaluating, and communication of objective information regarding the medical status and state of well being
Facilitates patient and caregiver access to community resources relevant to patient needs, including referrals to transportation programs, Meals on Wheels, senior centers, chore services
Provide an integrated holistic case management telephonic approach to those with chronic medical and behavioral health conditions with the goal of reducing the clinical gap between inpatient and outpatient services and potentially prevent hospital re-admissions
Authorize vendor services using clinically proven criteria to make consistent care decisions
Assist with discharge planning and care coordination to ensure optimal outcomes
Maintain accurate record of case management assessment and intervention including benefit and cost analysis for data collection and trending
Promote active involvement and initiative to members regarding their health care management and navigating health care delivery systems in order to preserve benefit resources
Communicate effectively with members, physicians, and providers
Be responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
Provides effective vendor management when assessing or managing cases
Nurse Case Manager Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Nurse Case Manager
List any licenses or certifications required by the position: BLS, CPR, CCM, ACM, CM, ABQAURP, URAC, AHA
Education for Nurse Case Manager
Typically a job would require a certain level of education.
Employers hiring for the nurse case manager job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Associates, Management, Education, Graduate, Health Care, Health, Nursing Program, Science, School of Nursing
Skills for Nurse Case Manager
Desired skills for nurse case manager include:
Microsoft Office programs
Managed care
Medical terminology
Excel
State
Financial aspects of third-party payors and reimbursement
Community resources
Word
Regulations
Utilization review
Desired experience for nurse case manager includes:
Work directly with the reimbursement specialist and the physician to secure funding for their patient’s therapies
Ability to work in a dynamic and evolving work environment
Strong knowledge of community healthcare resources preferred
A minimum of 5 years of current clinical experience, in the community setting preferred
Excellent telephone communication skills and organizational ability
Experience with making diagnoses and choosing, initiating, and modifying selected therapies in order to assist patients with optimizing their level of function and self
Nurse Case Manager Examples
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Nurse Case Manager Job Description
Job Description Example
Our growing company is looking to fill the role of nurse case manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for nurse case manager
- Participates with the clinical staff in the assessment of patient needs
- Completes, compiles and assembles all required paperwork for the patient client record, chart, as per corporate Policy and Procedures
- Provides patient education regarding receipt, storage and the administration of medications and supplies
- Assists the clinical staff in obtaining orders from the physician/practitioners office, only a registered pharmacist can obtain verbal medication orders directly from the physician/practitioners office
- Provides in-service training to the clinical and facility staff
- Addresses staff and/or member groups on specific topics of concern or interest within the expertise of the Nurse
- Acts as liaison between physicians/practitioners, medical consultants and facility clinical staff
- Participates in the corporate Quality/Performance Improvement program as required, in-service programs and continuing education/training programs as required
- Participates in on-call coverage after-hours, weekends and holidays as scheduled and or requested
- Completes written and verbal consultations with all levels of the claims staff that will clearly outline the answers on functional parameters the length and severity of the medical condition(s)
Qualifications for nurse case manager
- Strong clinical, interpersonal, priority setting and problem solving skills required
- Proven clinical practice experience, , hospital setting, alternative care setting such as home health or ambulatory care
- Clinically trained with Degree or recognized designation in western Medicine / Nursing or other western medical disciplines
- Minimum of one (1) year of clinical experience as a registered nurse (RN)
- Current knowledge and understanding of payments systems, HMO, PPO, Indemnity, Workers Compensation, insurance (Medicare and Medicaid
- Minimum of three years of clinical experience in applicable nursing specialty field
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Nurse Case Manager Job Description
Job Description Example
Our growing company is hiring for a nurse case manager. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for nurse case manager
- You’ll act as a medical consultant for our internal claims department team members, providing case management services that promote employees in their return to work
- You’ll review medical record documentation so that you can assess and evaluate medical conditions and history, diagnostic/test results and treatment
- Assists in projection of reserves for the life of the claim and collaborates with adjuster for roundtables
- Assesses healthcare needs associated with compensable/covered illness/injury claims and comorbidities
- Educates and evaluates injured/ill claimant/class member, insured party, and health care provider regarding patient's response to treatment to enhance claimant adherence and progress toward maximum medical improvement Return to Work planning
- Monitors and evaluates claimants' responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
- Collaborates with physicians, other medical providers, injured claimants and claims professionals to achieve optimal outcomes
- Acts to enhance injured workers’ adherence and progress toward maximum medical improvement
- Coordinates and monitors referrals to medical management vendors, as needed
- Effectively manages assigned caseload of medical/disability cases in accordance with Michigan PIP statute and company guidelines
Qualifications for nurse case manager
- Case Management expereince preferred
- Bachelor’s Degree in nursing and at least 1 year of prior nursing experience
- At least 1 year of experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary
- At least 1 year of basic Internet Explorer skills to include opening a browser, typing in URLs in the correct location, using a search engine, bookmarking a site, navigating using back/forward/stop buttons, and filling out forms online
- At least 1 year of experience in identifying operational issues and recommending and implementing strategies to resolve problems
- Certification in infusion IV nursing services
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Nurse Case Manager Job Description
Job Description Example
Our company is looking to fill the role of nurse case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for nurse case manager
- Interfaces with the member, family members/caregivers, and the healthcare team, internal matrix partners
- Collaborates with physicians, other medical providers, workers, employers and claims professionals to achieve optimal outcomes
- Monitors and evaluates inured workers’ responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
- Acts to enhance injured workers’ adherence and progress toward maximum medical improvement, , Return to Work planning
- Responsibilities include collecting, analyzing, and evaluating clinical documentation received using established criteria to determine appropriateness of clinical decisions
- Maintains a caseload of workers’ compensation claims
- Reviews medical aspects of all workers’ compensation claims and assists the University in return-to-work of injured workers and prevention of excessive injury costs by early identification of opportunities for appropriate medical intervention
- Have expertise in job functions within Patient Services group, mentoring, training and monitoring that area of responsibility
- Provide rigorous attempts to reach employer, injured worker and medical provider including sending correspondence if injured worker cannot be reached after several attempts
- Appropriately document all correspondence, contacts and actions on a claim in XCM per RTW standards
Qualifications for nurse case manager
- Bachelors degree in nursing with a valid license
- Member of O.I.I.Q
- Minimum of 3-5 years of experience in disability management
- Good knowledge of computers and Windows environment
- Analytical skills and ability to summarize information
- Member of CARNA
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Nurse Case Manager Job Description
Job Description Example
Our growing company is hiring for a nurse case manager. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for nurse case manager
- Complete all data entry requirements for managed care activities
- Completes in a timely manner, admission and continues stay criteria review to obtain “certification” and/or continues stay approval for selected Medicare, Medicaid, commercial and managed care patients
- Is available on a rotating basis on weekends, evenings, and holidays with other staff to provide onsite services from utilization review
- Complete Risk Assessment and Obstacle and Strategy report to appropriate parties by-product
- Establish a workers’ compensation and/or disability management program with customer including identification and coordination with medical providers, internal/external claims administrators and/or other external service providers
- Coach customers to refine and improve their workers’ compensation/disability management program in areas of injury report filing and in coordination with loss prevention, supporting provision of transitional duty by assisting customers in identifying industry specific light duty options as needed
- Actively participate in strategy sessions, client check in meetings and/or dispute resolution meetings as requested
- Obtain treatment plan and facilitate injured worker’s return to work and adherence to their treatment plan
- Provide customers with a plan of action, regular communication, support on injured worker’s treatment plan, early return-to-work as soon as medically feasible and ongoing return-to-work progress
- Coordinates the injured workers' medical treatment to ensure both cost effective and medically appropriate care is provided
Qualifications for nurse case manager
- Acute setting sub-acute or SNF facility experience
- Bachelor's Degree required, preferably in Nursing
- This position requires the ability to multi-task and interact with patients, family members, other staff and faculty
- Must have knowledge and understanding of case management
- Current Registered Nursing license required
- Current Certified Case Manager (CCM) or Certified Professional in Disability Management (CPDM) designation or the willingness and commitment to obtain such a designation within 2 years of hire
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Nurse Case Manager Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of nurse case manager. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for nurse case manager
- Facilitates the return to work process by acting as a liaison between the insured, medical provider, injured worker and the claims handler
- Provides the claims handler with appropriate disability timeframes through the utilization of the Official Disability Guidelines
- Questions the causal relationship between the treatment and injury claimed
- Coordinates treatment plans for cases involving catastrophic injuries and complicated medical conditions
- Oversees Vocational Rehabilitation activities in collaboration with the claims handlers
- Prepares medical cost projections and makes reserve recommendations upon request
- Provides medical education and guidance to claims handlers on complex files
- Maintains current knowledge of medical and rehabilitation trends
- Makes scheduled outbound calls and responds to inbound calls from patients and other customers regarding clinical aspects of a product, product administration, and adherence to medical therapies or treatments or for other related issues
- Providers wrap-around case management and care coordination services between patients, healthcare providers, and various settings of care
Qualifications for nurse case manager
- You’ll have a minimum of 4 years hospital or clinical experience in relevant medical fields
- Graduate of an accredited professional school of nursing required
- Active, unrestricted licensure as a Registered Nurse in Massachusetts
- Certified in Geriatric Nursing or Geriatric Case Management preferred
- Works effectively both independently member of an interdisciplinary team
- Fluency in French and French