Employee Health Case Manager at Bryan Health – Lincoln, Nebraska

GENERAL SUMMARY:

The Employee Health Case Manager practices according to the Standards of Care as defined by the Case Management Society of America. Assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet employee’s health needs, using communication and available resources to promote quality and cost-effective outcomes. Provides case management services for Worker’s Compensation claims, Short Term Disability cases and chronic illness and/or absenteeism related to health issues; coordinates Family Medical Leave (FML) and modified duty assignments.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Systematically assesses the circumstances of the employee’s medical case and identifies employees appropriate for case management according to established criteria:

a) Conducts case assessment with consideration for physical, psychosocial, environmental, spiritual and cultural factors; also considers personal motivation, financial factors, education level and vocational/learning capabilities.

b) Assesses medical history, current medical condition and prognosis.

c) Determines eligibility for FML according to the Family Medical Leave Act.

d) Communicates eligibility status to the employee.

e) Monitors and tracks FML hours and continued eligibility.

f) Coordinates and monitors modified duty assignments.

g) Coordinates the employee’s return to work.

3. *Analyzes assessment data to identify problems that require case manager intervention:

a) Identifies opportunities for intervention such as lack of an outcome focused treatment plan, compromised safety concerns, over- or under-utilization of medical services, premature or delayed discharge from services, use of inappropriate services, non-compliance, complications or lack of resources to meet health needs.

4. *Develops a case management plan that is cost effective and outcome based:

a) Collaborates with the employee, family, health care providers and insurance adjusters.

b) Communicates the plan of care with the employee.

c) Assists the employee in making informed decisions.

d) Advocates for the employee while being mindful of organizational resources.

e) Identifies measurable goals that are achievable within an appropriate time frame using evidence based criteria.

f) Identifies potential barriers to achieving the goals.

g) Identifies and makes referrals to appropriate resources.

h) Implements cost saving strategies whenever appropriate.

5. *Systematically and continuously evaluates the employee’s progress toward the established goal:

a) Maintains professional collaboration and communication with the employee, family and health care providers.

b) Interacts with attorneys who represent the Medical Center.

c) Interacts with third party administrators or insurance carriers.

d) Collaborates with the employee’s manager regarding ability to perform work duties.

e) Communicates with Human Resources regarding issues related to the employee’s employment status.

f) Strategizes with health care providers to alter the plan of care when needed to meet the established goal.

g) Makes referrals when appropriate.

h) Evaluates whether the established goal is achievable and appropriate; eliminates barriers to achieving the established goal.

i) Uses evidence based practice throughout the monitoring process.

6. Evaluates case management outcomes:

a) Reviews data collected to identify problem areas, such as access to resources, cost and quality of care.

b) Uses data to implement changes in practice patterns including interacting with the Safety Officer regarding injury prevention and overseeing documentation of injuries in the OSHA log.

c) Considers cost vs benefit when evaluating processes.

7. Documents all appropriate facts and circumstances about the case per department guidelines; uses software systems competently and maintains appropriate paper documents in the employee’s health file.

8. Performs basic Employee Health clinic duties including:

a) Performing clinical assessment for illnesses/injuries, including but not limited to vital signs, physical assessment, health history, health screenings, i.e., TB skin tests, strep screens, blood pressures, etc.

b) Develops a nursing care treatment plan.

c) Carries out nursing interventions including but not limited to medication administration, immunization administration, nursing procedures, counseling and education and referrals as appropriate.

d) Evaluates nursing care outcomes and documents the visit appropriately.

9. Maintains confidentiality of medical and personal information.

10. Attends staff meetings, mandatory inservices and other meetings/appointments as required.

11. Advances work knowledge by participating in continuing education inservices, reading periodicals/literature and seeking ongoing development opportunities; serves as a role model and mentor to nursing students and others.

12. Performs other related duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act. Must provide evidence of certification and/or instruction for practice area as required by State or Federal standards/regulations. Bachelors of Science in Nursing degree preferred. Minimum of one (1) year experience practicing case management or occupational health nursing required. Certification from a case management organization preferred.

OTHER CREDENTIALS / CERTIFICATIONS:

Basic Life Support (CPR) certification required.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT)—Characterized as light work requiring exertion of up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.