Nurse Planner

Are you are RN and passionate about healthcare? Do you want to contribute to a dynamic, values-oriented workplace? If so, you’ll fit right in with the team at ExamWorks Clinical Solutions (ECS).

The Nurse Planner works autonomously to develop any and/or all of the following:  Life Care Plans, Medical Cost Projections, Limited Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and certifications.

This is a full-time position, Monday-Friday, 8am-5pm. 

ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

• Collects, reviews and analyzes health data from medical records and/or other sources as provided.

• Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care.

• Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed.

• Maintain a quality work product evidenced by acceptable quality scores/score cards.

• Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company.

• Attend all scheduled conference calls as mandated by management.

• Maintain any required credentials and adhere to all codes of ethics required by these credentials.

• Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times.

• Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines.

• Promote effective and efficient utilization of company resources.

• Participate in various educational and or training activities as required.

• Perform professional duties as assigned by the Manager or upper management.

Education and/or Experience

Minimum of an Associates degree or equivalent certification preferred. A minimum of two years workers’ compensation and/or case management experience preferred. A minimum of one year experience in Medicare Set Asides required.

Certificates, Licenses, Registrations

Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Active unrestricted Adjuster license. Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting.

QUALIFICATIONS

• Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations.
• Must be able to adequately operate a general computer, fax, copier, scanner, and telephone.
• Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Ability to demonstrate critical thinking and problem solving skills.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently, prioritize work activities and use time efficiently.
• Ability to concentrate and multitask in a fast paced work environment.
• Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Must be able/willing to work on a flexible schedule when needs arise.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Demonstrates reliability and abides by the company attendance policy.

LANGUAGE/COMMUNICATION SKILLS

• Ability to read, analyze and interpret common to complex correspondence, medical records, various reporting records, legal contracts and/or related case documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.
• Demonstrates reliability and abides by the company attendance policy.

LANGUAGE/COMMUNICATION SKILLS

• Ability to read, analyze and interpret common to complex correspondence, medical records, various reporting records, legal contracts and/or related case documents.
• Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
• Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
• Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position generally consists of:

• Sitting 5-7 hours per day during office time requirements.
• During day travel sitting, standing and/or walking for blocks of time may be required.
• Occasionally climbing one or more flight of stairs
• Occasionally lifting and/or carrying up to 10 lbs.
• Occasionally pushing/pulling up to 10 lbs.
• Occasionally subject to bending, squatting or twisting.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Extended hours are occasionally required beyond the regular eight (8) hour work day.
• Works in a home office environment and/or occasionally from an office environment.
• The noise level in the work environment is usually moderate, but may vary during travel.

DISCLAIMER

This Job Description is not an exhaustive list of all functions employees may be required to perform in the described role, and additional functions may be required. ExamWorks reserves the right to revise this Job Description at any time with or without notice to employees. Employment with ExamWorks is at-will, and nothing in this Job Description changes that at-will status. Employees must be able to perform the essential functions of this position satisfactorily. If requested, reasonable accommodations may be made to enable employees with disabilities to perform the essential functions of this position, unless such accommodations would cause an undue hardship to ExamWorks.

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans