Making Numbers Make Sense
Cardiac Telephonic Nurse Case Manager
Location
Alabama
Posted
5 days ago
Salary
$80K - $85K / year
Seniority
Senior
Job Description
Cardiac Telephonic Nurse Case Manager
MDD Forensic Accountants
• Utilize advanced cardiac clinical knowledge to review, evaluate, and coordinate treatment plans involving cardiovascular conditions, cardiac procedures, and related medical care. • Monitor recovery progress and treatment outcomes for injured workers with cardiac injuries, diagnoses, or comorbidities. • Collaborate with treating physicians, cardiologists, healthcare providers, employers, adjusters, and injured workers to support optimal medical and return-to-work outcomes. • Evaluate medical necessity and appropriateness of cardiac treatment plans utilizing evidence-based treatment guidelines and clinical best practices. • Identify barriers to recovery specific to cardiac conditions and develop appropriate intervention strategies. • Educate injured workers regarding cardiac diagnoses, treatment recommendations, medication compliance, lifestyle modifications, and recovery expectations as appropriate. • Review medical records, treatment plans, diagnostic testing, and provider recommendations. • Encourage injured worker participation in treatment and recovery plans. • Evaluate return-to-work capabilities and discuss restrictions with providers and employers. • Obtain and review job descriptions to assist providers in determining appropriate work capacity. • Coordinate modified duty and transitional return-to-work opportunities when medically appropriate. • Adhere to state treatment guidelines, evidence-based protocols, account requirements, and organizational standards. • Monitor compliance with ODG, ACOEM, state-specific treatment guidelines, and utilization criteria as applicable. • Identify cases requiring utilization review, physician review, pre-certification, pre-authorization, concurrent review, or retrospective review. • Track treatment outcomes, disability durations, and return-to-work progress. • Maintain timely, accurate, and thorough case documentation within electronic case management systems. • Ensure compliance with HIPAA and all applicable state and federal privacy regulations. • Serve as a patient advocate while maintaining legal, ethical, and regulatory standards. • Participate in quality improvement initiatives, client meetings, and team collaboration activities as needed. • Assist with training, mentoring, and knowledge-sharing opportunities when appropriate. • Perform additional duties and special projects as assigned.
Job Requirements
- Active Registered Nurse (RN) license with proof of current state licensure.
- Minimum of 3 years of clinical nursing experience.
- Minimum of 3 years of Workers' Compensation case management experience preferred.
- Recent cardiac clinical experience is required.
- Cardiac experience may include one or more of the following:
- Working on a Cardiac Unit or Cardiac Step-Down Unit.
- Critical Care/ICU experience managing cardiac patients.
- Experience titrating cardiac drips and monitoring complex cardiac conditions.
- Employment within a Cardiology Practice or Cardiology Provider Office.
- Interventional Radiology experience supporting cardiac procedures.
- Cardiac Catheterization Lab experience.
- Cardiovascular Case Management experience.
- Other direct cardiac care experience involving the treatment and management of cardiac patients.
- Strong understanding of cardiac conditions, treatment protocols, procedures, medications, diagnostics, and recovery planning.
- Ability to independently review and interpret medical records, treatment plans, diagnostic studies, and physician recommendations.
- Strong clinical assessment, care coordination, and communication skills.
- Ability to work independently in a telephonic case management environment.
Benefits
- Medical, dental, and vision plans to support your health and that of your family
- A 401(k) plan with employer matching
- Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees
- Paid holidays
- Life insurance and short-term and long-term disability coverage
- Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements
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