RN Needed for Next Step Medical Advisory Program
The Next Step Medical Advisory Program℠ is a collaborative process to advise our clients on complex Workers Compensation cases. This RN would apply technical knowledge and experience, while also coordinating participants in the process. A background in workers compensation and/or case management is strongly preferred. Responsibilities include, but are not limited to:
Work specifics: non-exempt, working from the San Jose office, with local travel as needed:
· Gather additional information and work with involved parties to obtain needed information: i.e. Pharmacy bills, updated records, physician information, etc… on a case by case basis.
· Assist in obtaining the signed Next Step referral form with the direction and goals from the carrier or applicable parties. Obtaining the medical records and time frame for receipt of records.
· Update all applicable parties as to receipt of referral, medical records, direction, updates and status of the case within the Next Step.
· Prepare cost savings analysis and projected cost savings as well as preparation of final cost savings.
· Liaison to any case management assigned to gather information. Act as the TCM or FCM on the case where appropriate.
· Attend strategic meetings internally and externally to define direction and additional needs.
· Coordinate and communicate the dates , times, and call in numbers for all meetings internally and externally for strategic plans, round table discussions, peer to peer, and any other meetings necessary with vendors, etc. to impact the case.
· Coordinate physicians, nurses, defense attorneys, adjusters, claims managers, consultants, and any additional applicable parties for meetings, file reviews, recommendations, weekly updates, letters, documents needed as well as other duties on a case by case basis.
· Take notes for all meetings and follow up with updates to all parties.
· Coordinate and implement all peer-to-peer telephonic meetings. Responsible for ensuring that the EK physician is on the call and prepared with the plan of action for the peer-to-peer conversation.
· Enter all notes into the case on Ahshay as to all activities that are done on a weekly basis or more defined by the program coordinator’s activities.
· Set realistic time frames for completion of each step to include but not limited to:
o File Review portion
o Round table meetings
o Follow up on recommendations and plan of action
o Implementation of the steps for impact
· Assist in tools for the cost projection as well as the final cost savings to be done by the designated EK nurse.
· Confer with CMO and specialty reviewers on the case for appropriate direction of which physician will complete the file review with his/her recommendations.
· Complete all reports and billings including physician time. Oversight of the query to ensure that the level pricing stays within the signed perimeters. If above the authorized costs, contact the applicable party to obtain additional authorization on the level for costs.
· Other duties as assigned
Job Requirements:
- Graduate of an accredited school of nursing
- Valid California RN license in good standing with no restrictions
- Valid state-appropriate Drivers license in good standing
- Possess and demonstrate the professional and technical skills of a Registered Nurse
- Experience in Field Case Management, Workers' Compensation experience highly preferred, but not required
- Excellent Interpersonal, Written and Oral Communication Skills
- Strong Organization Skills
- High comfort level with computers and computer programs (MS Word, MS Excel, Email)
- Ability to work independently with minimal supervision
- Ability to meet deadlines in a high pressure, time sensitive environment
- Ability to lift up to 20 lbs
- Sit (approx. 75+% of the time), stand (approx. 10-25% of the time), type (50-75% of the time) and do the job with or without reasonable accommodation.
To apply, please provide a resume to Jenna Schrader, HR Manager, at jschrader@ekhealth.com.
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