IPMG

Manager

• Conduct initial and ongoing assessments to identify patient status and individual needs
• Promote client self-determination
• Identify appropriate providers and facilities across the continuum of services
• Use resources and case management interventions to facilitate case management plans
• Develop case management plans with consumers and healthcare team members
• Identify goals, interventions, resources, reevaluation timeframes, and collaborative approaches
• Execute and document case management activities and interventions
• Gather information and documentation to determine plan effectiveness
• Evaluate and document plan effectiveness and modify plans as appropriate
• Measure and modify interventions to determine outcomes
• Facilitate authorizations and referrals within benefit structures, contracts, and regulations
• Document contacts according to best practices and required templates
• Notify claims personnel about anticipated surgeries, benefit exceptions, and significant events
• Proactively manage disability durations using evidence-based criteria
• Collaborate with patients/injured workers, providers, clients, employers, and internal team members
• Perform triage intake and coordinate care according to client instructions
• Administer leave and manage short-term disability according to regulations, policies, and plan documents
• Primarily support short-term disability and workers’ compensation, with potential group health benefits case management

Nurse Case Manager I