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Provides ongoing evaluation and nursing case management services, meeting with clients in their homes, work-sites, or physician's or therapist's office. Assesses, evaluates, and analyzes injured workers’ medical and/or vocational status, and develops, coordinates, and implements a viable, realistic service plan. Monitors the progress of the injured/disabled individuals and reports results back to the employer and insurance carrier.: Develops a plan of care for patients from admission to discharge. Monitors individuals’ progress toward desired outcomes through assessments and evaluations. Communicates both in-person and by phone with client, medical providers, attorneys, employers, employees, insurance carriers, etc. Develops and administers education and prevention programs. Develops guidelines for working with patients, healthcare management companies, insurance companies, or other third party payers to determine quality, cost-effective care. Applies all special instructions required by individual insurance carriers and referral sources. Applies all laws and regulations that apply to the provision of rehabilitation services. Testifies when called upon to do so, to substantiate any casework or reports that may be seen as relevant to hearing involving client. Evaluates outcome of patient care. Prepares reports and other required paperwork as documentation of all casework activities. May arrange referrals, consultations, therapeutic services, and confers with other specialists on course of care and treatment.

Case Supervisor

Supervises and coordinates activities of social-service-agency staff and volunteers, and students of school of social work: assigns caseloads and related duties, and coordinates activities of staff in providing counseling services to assist clients with problems of emergency or crisis nature. Assists agency staff members through individual and group conferences in analyzing case problems and in improving their diagnostic and helping skills. Reviews case records and evaluates performance of staff members and recommends indicated action. Participates in developing and implementing agency administrative policy. Counsels clients individually or in groups on planned or experimental basis and in emergencies. Trains new employees in areas such as agency policy, department procedures, and agency or government regulations. Provides in-service training for experienced workers in areas such as new policies, procedures, and regulations. Represents agency in community or in interagency activities. May conduct or direct staff development programs. May train workers is use of computer. Employed in areas such as child welfare, community welfare councils, family casework, youth services, senior citizen services, health services, public welfare, probation and parole, housing relocation, education, and rehabilitation. Usually required to have master's degree from school of social work.

Case Packer & Sealer

Tends machine that packs and seals cartons of cigarettes in shipping cases: starts machine and conveyor belt and observes flow of cartons on conveyor to determine whether cartons are filled and sealed according to specifications and that date stamp is legible. Removes defective cartons. Shapes collapsible cases and places open end of case over mouthpiece of packing unit, or loads blank shipping cases onto feed magazine. May adjust counting and weighing mechanism on packing machine.

Consultant Educational State Board of Nursing

Directs activities concerned with maintaining educational standards established by board of nursing or other legally authorized agency: participates in development and implementation of philosophy, purpose, policies, and plans of board of agency, and consults with and advises administrators of nursing schools in regard to curricula and facilities for instruction. Plans and conducts surveys of nursing schools and advises institutions desiring to establish schools on policies and procedures. Maintains current and comprehensive records and reports and keeps informed on trends and developments within the profession. May assist with administrative functions.

Nurse Consultant

Advises hospitals, schools of nursing, industrial organizations, or public health groups on problems related to nursing activities and health services. Position is a clinical specialist or consultant requiring comprehensive specialized health and medical care knowledge. This position typically requires advanced study in the field of nursing or health sciences. Requires RN license.: Reviews and suggests changes in nursing organization and administrative procedures. Analyzes nursing techniques and recommends modifications. Provides assistance in developing guides and manuals for specific aspects of nursing services. Prepares educational materials and assists in planning and developing health and educational programs for industrial and community groups. Advises in services available through community resources. Consults with nursing groups concerning professional and educational problems. Prepares or furnishes data for articles and lectures. Participates in surveys and research studies. May have broad hospital-wide activities. May aid schools in planning nursing curriculums. May aid hospitals and public health nursing services in developing and carrying out staff education programs.

Nurse Case Manager

Coordinates managed care cases of plan members admitted to the provider plan facilities and/or members utilizing services outside the provider plan facilities. Case coordination typically includes prospective and retrospective review that includes, but is not limited to, prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for patients from admission to discharge. This managed care position is typically filled by a registered nurse with current State license.: Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment.

Medical Nurse Case Manager

Inpatient Nurse Case Manager

Coordinates the delivery of healthcare and social services to the inpatient population while balancing individually identified patient and family, medical, and psychosocial needs with cost-effective and available resources. Manages the inpatient hospital stay of a caseload of patients through coordination with physicians, social workers, nursing staff, and other health professionals. Reports to the Nurse Manager of assigned unit.: Performs utilization review and collaborates with the care team to formulate the discharge plan. Implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for the patient to an appropriate lower level of care in collaboration with the hospitalist/physician member team, acute or skilled facility staff, ambulatory care team, and the patient and/or patient's representative from admission through discharge. Interfaces with physicians, nursing staff, and other members of the multidisciplinary and medical records coding staff to ensure appropriate reimbursement is received. Determines medical necessity for admission and continued stay according to specific criteria and regulations in accordance with the Utilization Review Plan. Conducts daily/concurrent reviews of charts to rectify any deviation from compliance. Educates staff, physicians, and other members of the multi-disciplinary team on documentation for compliance. Identifies consistent clinical and operational problem areas and facilitates resolutions through participation in the performance improvement process. Acts as liaison for the management and communication of information with the insurance/managed care companies of the assigned patient population.

Ambulatory Nurse Case Manager

Works with enrollee's providers and caregivers in a health plan to provide intensive, comprehensive case management and increase efficient utilization of services. Typically requires Registered Nurse licensure with patient care experience. Certified Case Manager (CCM) certification may be required.: Identifies chronic or catastrophic cases through the case management process and initiates intensive case management according to program guidelines. Evaluates the medical necessity for elective inpatient hospital admission, and authorizes the admission along with the estimated length of stay. Consults with Inpatient Nurse Case Managers regarding existing case management enrollees as well as potential case management enrollees. Screens for the medical necessity of outpatient procedures, home medical equipment, medications, and any other service that requires precertification. Retrospectively reviews medical admission of categories of diseases and procedures. Makes recommendations for standards of care as necessary. Identifies quality indicators through the case management process. May direct abnormal lengths of stay to the Medical Director or Associate Medical Director. May perform on-site reviews for back-up to an Inpatient Nurse Case Manager.

Medicare Nurse Case Manager

Plans, directs, implements, and evaluates appropriate healthcare services for Medicare patients in conjunction with Physician's treatment plan to ensure that cost effective, quality care is provided. Typically requires licensure as a Registered Nurse with three years of relevant nursing and medical case management experience. Certification as a Case Manager or professional certification in a clinical specialty may also be required.: Coordinates cases that normally include prospective and retrospective review and prior authorization, determining the appropriate level of care and utilization of services, concurrent review, retrospective review, developing discharge plans, and ensuring quality cost effectiveness. Develops a plan of care for Medicare patients from admission to discharge. Monitors patient progress toward desired outcomes through assessments and evaluations. Develops and administers education and prevention programs for Medicare patients. Analyzes referred cases for potential case management interventions. Evaluates the effectiveness of alternate care services and ensures that cost effective, quality care is maintained to meet case management objectives. Determines if proposed medical treatment plans meet contract provisions. May arrange referrals, consultations, therapeutic services, and confer with other specialists on course of care and treatment. May negotiate fees with providers of medical care, agencies, and outside vendors to achieve maximum cost effectiveness.

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