RN Case Manager

Job Description: Occupational Health Case Manager

Company: One to One Health (Rivian Health Hub)

Location: Normal, IL

Job Type: Full-Time

Reports to: Practice Manager

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Job Summary

Rivian Health Hub is seeking a dedicated, organized, and proactive Workers' Compensation Case Manager to join our occupational health team. The Case Manager is the central point of communication for an injured employee's case, acting as a liaison between the patient, employer, insurance carrier, and our clinical team. The primary goal of this role is to facilitate the patient's optimal medical recovery and ensure a safe, timely, and cost-effective return to work.

The ideal candidate will be an exceptional communicator with a strong understanding of workers' compensation processes and medical terminology, dedicated to providing excellent service and achieving positive outcomes for all stakeholders.

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Key Responsibilities

• Case Coordination: Serve as the primary point of contact for all parties involved in a workers' compensation claim, including the injured employee, Rivian leadership & EHS staff, insurance adjusters, and medical providers.
• Communication: Proactively communicate case status, treatment plans, and work-status updates to all relevant parties.Ensure clear, concise, and timely dissemination of information.
• Treatment Plan Management: Collaborate with physicians, physical therapists, and other healthcare providers to understand and manage the patient's treatment plan. Schedule appointments, specialist referrals, and diagnostic tests as required.
• Return-to-Work (RTW) Program: Implement, and monitor return-to-work plans, including coordinating modified or light-duty assignments with Rivian Leadership. Actively identify and address any barriers to a successful RTW.
• Authorization & Utilization Review: Obtain necessary authorizations for treatment from insurance carriers. Provide clinical information to support the medical necessity of care and facilitate the claims process.
• Documentation: Maintain meticulous, accurate, and confidential case records within the Electronic Medical Record (EMR) system. Document all communications, actions, and progress notes related to each case.
• Regulatory Compliance: Ensure all case management activities adhere to state-specific workers' compensation laws, HIPAA regulations, and company policies.
• Patient Advocacy & Education: Educate injured employees about the workers' compensation process, their treatment plan, and their role in recovery to empower them and alleviate concerns.
• Case Closure: Monitor cases through to completion, ensuring Maximum Medical Improvement (MMI) has been reached and all necessary documentation for case closure is finalized and distributed.

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Qualifications and Requirements

Required:

• High school diploma or equivalent.
• A minimum of 2-3 years of experience in a workers' compensation case management, claims adjusting, or a similar role within a medical or insurance environment.
• Strong knowledge of state workers' compensation laws and regulations.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience working with Electronic Medical Record (EMR) systems.
• Excellent verbal and written communication skills, with the ability to communicate effectively with individuals at all levels.

Preferred:

• Associate's or Bachelor's degree in Nursing, Healthcare Administration, Business, or a related field.
• Clinical background or certification (e.g., RN, LPN, MA, CCM - Certified Case Manager).
• Experience working directly within an occupational health or orthopedic clinic setting.
• Bilingual in English and Spanish is highly desirable.
• Familiarity with medical terminology, particularly related to musculoskeletal and workplace injuries.

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Skills and Competencies

• Organizational Skills: Superior ability to manage multiple cases simultaneously, prioritize tasks, and meet deadlines in a fast-paced environment.
• Attention to Detail: Meticulous approach to documentation and communication to ensure accuracy.
• Interpersonal Skills: Ability to build strong, professional relationships with patients, clients, and colleagues. Demonstrates empathy, patience, and active listening.
• Problem-Solving: Strong critical thinking and analytical skills to navigate complex cases, identify barriers, and develop effective solutions.
• Professionalism: Maintains a high level of confidentiality and professional conduct at all times.
• Team Player: Works collaboratively with the clinical and administrative teams to achieve clinic goals.

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Work Environment

This position operates primarily in a professional office environment within a medical clinic. This role routinely uses standard office equipment such as computers, phones, and photocopiers.