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One Call Care Management 11 days ago
location: remoteus
Apply Now

Clinical CC I – RN

Work from Home, United States

req11167

We’re looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our erse and inclusive culture and help us live out our mission of “getting people the care they need when they need it.” Over the last 30 years, our company has established itself as the market leader in managed care for the workers’ compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.

Salary Range: 19.04 – 28.56 Hourly

Salary may vary based on location, years of experience, qualifications, and skill set.

Benefits Summary:

In return for your commitment to our company’s mission, we offer a vast array of benefits to help support the whole you.

  • Opportunities to work from home
  • Competitive wages with opportunities to earn annual merit increases
  • Paid development hours to use for professional and community development!
  • Generous paid time off, 8 company holidays, and 2 floating holidays per year
  • $1,000 Colleague Referral Program
  • Enterprise Recognition Program rewarding colleagues for their extraordinary work
  • Exclusive discounts on travel, activities, and merchandise via work discount program
  • Colleague Assistance Program that provides free counseling and financial services
  • Tuition Reimbursement Program including certifications
  • Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions
  • Medical, dental, and vision insurance
  • Pre-Tax FSA and HSA health savings accounts
  • 401(k) matching
  • Company paid life insurance
  • Company paid short term and long-term disability
  • Referral program
  • Healthcare concierge
  • The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.

JOB SUMMARY:

Provides support to the carrier in coordination of workers’ compensation patients until the case is closed by the carrier and/or discharged by the physician.

Clinical Care Coordinator I

Entry level role. Basic skills with moderate level of proficiency. Generally performs a high volume of basic inquires about One Call Care Management’s products and services by following standard scripts and procedures. Works under close supervision without latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Typically requires zero to one year of experience in a call center or customer service-related position in a service industry. Zero- 2 years of experience in the workers compensation industry. Associates will handle one service line or more and will become knowledgeable in these areas before moving into a level II role.

GENERAL DUTIES & RESPONSIBILITIES:

· Manages the completion on any portion of process that Care Coordinator was unable to complete, if any.

· Facilitates flow of evaluation(s), orders, and progress notes from provider(s) to Nurse Case Manager or adjuster per One Call Care Management’s nursing department protocol.

· Reviews MD orders, initial assessments/evaluations and progress notes on patient, and communicates with provider and carrier per One Call Care Management’s Nursing department procedure to provide updates and ensure progress of patient.

· Locates provider(s) or contact established provider(s) to arrange additional service for current patient.

· Communicates with Nurse Case Manager/adjuster and/or provider to ensure appropriate physician orders are obtained and followed.

· Contacts Nurse Case Manager or Adjuster to obtain authorization for additional or continued service(s).

· Creates purchase order(s) per One Call Care Management’s nursing department procedure to authorize additional or continuation of service(s) to provider.

· Utilizes appropriate tracking tools, i.e. authorization logs, Outlook Calendar or Task function, to ensure follow-up on critical timelines as outlined in One Call Care Management’s nursing department procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers.

· Coordinates quality assurance issues or concerns involving patient care, retrieval of evaluations and/or notes, and authorization of services closely with assigned Quality Assurance nurse.

· Maintains thorough, up-to-date documentation on each patient in patient database.

· Closes file per One Call Care Management’s nursing department procedure once Nurse Case Manager or adjuster cease authorization or physician discharges from home care.

· Notifies appropriate One Call Care Management’s department(s) of referrals requiring their expertise.

· Assists in training new associates as requested by Nursing Department Training Leader.

· Performs special projects as assigned and prioritized by management.

EDUCATIONAL REQUIREMENTS:

Registered Nursing degree; (R.N., L.P.N., or M.A.) with a minimum of two (2) years of experience in acute setting, home care, or front and back medical office.

GENERAL KNOWLEDGE, SKILLS & ABILITIES:

· Knowledge of the company’s products, services and business operations to enable resolution of customer inquiries

· Excellent customer service skills that build high levels of customer satisfaction

· Excellent verbal and written communication skills

· Computer navigation and operation skills

· Demonstrates effective people skills and sensitivities when dealing with others

· Ability to work both independently and in a team environment