COMPANY DESCRIPTION

Pinnacle Case Management Solutions, LLC provides nurse case management services to employers, third-party administrators, and insurance carriers in the Workers' Compensation industry. Our dedicated team of nurses support all parties involved in the recovery process, including the claim examiner, employer, provider, and injured worker. We are committed to ensure the highest level of care and assistance.

JOB DESCRIPTION

Nurse Case Manager (Bilingual)

Pinnacle Case Management Solutions has an immediate need for a full-time, Field Nurse Case Manager in the Workers' Compensation industry who is Bilingual, to cover Los Angeles County, CA and surrounding areas. This remote, home-based role involves local travel to doctors' offices, hospitals, and other locations. As a Field Nurse Case Manager, you will manage the medical cases of work-related injuries through assessment, planning, coordination, implementation, and evaluation of injured/disabled individuals. You will work closely with insurance carriers, medical care providers, attorneys, employers and employees, monitoring the progress of the injured workers and reporting results to the employer and insurance carriers. Daily tasks include effective communication with all parties involved and recommending cost-effective resources to facilitate individualized treatment goals, including timely return to work if appropriate.

Essential Position Requirements

Nurse Case Management skills within the Workers' Compensation industry.
Bilingual proficiency in English and Spanish.
Active Registered Nurse (RN) license or LVN license from the state of CA required at time of hire.
Excellent communication and interpersonal skills.
Ability to work collaboratively and independently.
Strong organizational and time management skills.
Identifies delays in service requests or treatment and communicates them to the team so steps can be taken to eliminate or minimize delays.
Communicates timely, professionally, and comprehensively with injured workers, claims adjusters, attorneys, employers, providers, clinics, and other parties with information relevant to a claim.
Valid CA driver’s license.

Primary Responsibilities

Maintains regular contact with all parties including the injured worker, adjuster, physician and employer involved to facilitate communication and to provide medical and vocational management and coordination services.
Maintains constant contact with the adjuster assigned to the file through telephone calls, email, and written reports.
Drives to doctors' offices, hospitals, and various other local locations.
Organizes and reviews medical records to identify specific medical issues; Provides information and recommendations to appropriate parties.
Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations).
Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services.
Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary.
Works with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved.
Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports.
Develops Independent Medical Evaluation Plan. Provides assessment, planning, implementation, and evaluation of patient's progress
Facilitates authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed.
Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim. Works with the treating physician to update any conditions as medical treatment progresses
Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment, ensuring the job is consistent with any physical restrictions assigned by the treating doctor.
Educates the employer on the benefits of accommodating the injured worker to keep him in the work force.

APPLY TO WORK WITH US!

If you align with our core values of commitment to service, results, and a caring family culture, we invite you to apply. We are eager to learn about you and appreciate the time you dedicate to this process.

THANK YOU!

We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated.

Salary

Range: $90,000 - $120,000 per year

Pinnacle Case Management Solutions, LLC.

New Jobs

Case Management Nurse