Job Description:


Location: Sacramento, CA, USA• Rocklin, CA, USA• Modesto, CA, USA
Req Number: Req #1204

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

JOB TITLE: Case Manager

SUMMARY: The Case Manager is responsible for the medical case management of work-related injuries, which includes assessment, planning, coordination, implementation and evaluation of injured/disabled individuals. A Case Manager works independently using his/her own discretion with the objective of following the organization’s best practices to assist injured workers/consumers in their recovery and returning to work at the highest level of function as possible. Case Managers must adhere to their scope of practice for a license and/or certification and follow state guidelines for licensure and/or national certifications. The Case Manager works with all parties to the claim including: the injured person, the claim’s examiner, employer, attorneys (plaintiff and defense) and medical providers.

DUTIES AND RESPONSIBILITIES:

• Accepts cases for referral and management in accordance with Medical Case Management Standards of Practices and established caseload.
• Counsel, direct and motivate consumers to reach their highest level of function.
• Establishes relationships and maintains communications with consumers, families, providers, Paradigm’s carrier clients and employers. Ensures that all communication is culturally sensitive and meets requirements to maintain injured worker confidentiality.
• Completes accurate and timely written reports in accordance with Paradigm documentation standards.
• Ensures that case management plan is implemented, and care is coordinated to ensure achievement of case management interventions. Documents progress towards achievement of case management intervention and evaluate progress on an ongoing basis, modifying the case management plan if indicated.
• Assist sales/marketing team as needed to build caseload. Develop solid relationships with customers in order to ensure repeat business.
• Responsible for complying with Paradigm IT security requirements and policies.
• Responsible for safeguarding Paradigm or Paradigm related IT passwords.
• Adheres to quality assurance standards and department processes.
• Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management.
• Responsible for maintaining an active license and/or certification and completing all renewals with any state requirements prior to the expiration date(s).
• May be asked to obtain additional licenses, certifications, or state registrations according to the organization’s business needs.
• Must be able to work in a virtual environment. Must adhere to the Paradigm Remote Working Policy and Guidelines.

QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND EXPERIENCE

i. Current, unencumbered Registered Nurse (RN) license allowing for practice in the United States.

• Experience in case management of workers comp cases, preferred.
• Recommended certifications (CCM, CRRN, CDMS, CRC) preferred

ii. Or, if the individual does not have a RN license, the applicant must meet the following requirements

• A minimum of a 4-year Bachelor of Arts/Science in a health-related field that meets national certification criteria and allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline; or
• A Master’s level (MA) in Vocational Rehabilitation or related fields; or
• A Master’s degree in Occupational Therapy

And

• Have a national certification for case management, i.e., CCM, CRRN, CDMS.CRC.

iii. Requirements for all applicants:

• Must adhere to the standards of practice outlined by the specific license, national certifying body, or the jurisdictionally accepted standards of practice.

• Two years of full-time equivalent direct clinical experience to the consumer (required for casework referred from Accounts requiring accredited case management).
• Professional licenses or certifications required to meet qualifications for this position and any state requirements must be current, unrestricted and allow for practice within a state or territory of the United States.
• Must be skilled at patient education.
• Ability to operate autonomously with minimal oversight
• Skills required for success: organization and timeline adherence skills, PC and technology skills, communication skills (written, verbal, and interpersonal).
• Valid driver’s license, and safe driving history

COMPETENCIES

• Exceptional time management and organization skills are required. Best practices are adhered to for all case assignments.
• The ability to communicate effectively with a wide range of people on a daily basis utilizing both verbal and written communication.
• Flexibility, versatility, and problem solving – this role works at a fast pace.
• Technology proficiency - Case Managers at Paradigm CCS use an advanced Case Management software solution to do their work. A laptop and cell phone are used daily.
• Strong clinical skills - Case Managers do not provide direct patient care but they rely on their strong clinical skills to exercise discretion and make an independent judgement of treatment and progress in order to make an impact on their injured workers.
• The desire to help others and you succeed.
• Self-motivated and ability to work independently.
• Proven decision-making and critical thinking skills, requiring little supervision.
• Problem solving and conflict resolution/negotiation skills.

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.

• Ability to perform the physical demands of the Light work Category defined as:

Work which involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds and requiring a good deal of walking or standing. A job is included in this category when it involves sitting most of the time with some pushing and pulling of arm or leg controls. In order to be considered capable of doing light work, an individual should have the ability to do substantially all the activities. A person who can do light work is deemed to do sedentary work unless there are additional limiting factors such as loss of fine dexterity or inability to sit for a long time.

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.

• Field/Home Office Environment: Home office plus travel between worksites and clients. The environment may vary between clients to include, but not limited to, residential homes, clinics, hospitals, manufacturing and normal office areas. Equipment: telephone, mobile devices, personal computer, calculator, fax machine, etc.

• Position may require driving of personal or leased automobiles for completion of task. Employee must maintain minimum insurance requirements for coverage.

Initial Motor Vehicle Report (MVR) must be completed and approved by the insurance carrier. Annual MVR reports will be completed by carrier, employees whose MVR do not meet carrier standards may have the terms of their employment change as a result of poor driving.

Employees must notify their supervisor of any accidents in the course of driving, as well as any adverse incident which will impact the MVR.

EMPLOYEE ACKNOWLEDGEMENT AND ACCEPTANCE

I have access to a number of Paradigm data systems and information in my position. Some or all the systems contain confidential, personal and/or health information. I understand that if I disclose any of the above information without authorization, such disclosure may be grounds for immediate termination of my employment.

I acknowledge I have received and read my job description and understand and accept the responsibilities, qualifications, physical demands, and work environment this position requires.

Furthermore, I understand Paradigm may run pre- and post-employment background checks on me.

__________________ /__________________ / ____

Employee (print name) Employee Signature Date

Although the Case Manager may hold a professional license, the Case Manager will not be considered to be in the practice of that profession as that term may be defined by certain state laws. Provided, however, the Case Manager will be using and relying on the skills, knowledge, and expertise developed in earning the applicable license or degree.

Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Other details

PI250318542

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