Posted Tuesday, February 25, 2025 at 6:00 AM
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: Professional Case Manager
SUMMARY: The Case Manager is responsible for the medical case management of injuries including catastrophic injuries. This role is responsible for the assessment, planning, coordination, implementation, and evaluation of injured/disabled individuals. A Case Manager works as an independently licensed professional as part of a systematic care team to assist injured workers/consumers in their recovery so that they may return to the highest level of function as possible. Professionals in this role must adhere to their scope of practice for a license and/or certification. The Case Manager works with all parties to the claim including the injured person, the claim examiner, employer, attorneys (plaintiff and defense), and medical providers.
DUTIES AND RESPONSIBILITIES:
Accepts cases in accordance with Medical Case Management Standards of Practices and established caseload as per required productivity.
Educates and motivates consumers to reach their highest level of function.
Field Case Manager : Conducts on-site assessments with the injured consumer and/or their medical provider, gathers data, and initiates the case management process. Referrals may include cases that have varying degrees of severity. Expectation may be that the case manager’s hours will vary depending on the case assignment and tasks required.
Telephonic Case Manager : Conducts telephonic assessments with the injured consumer, gathers data, and initiates the case management process. Referrals may include cases that have varying degrees of severity. Expectation may be that the case manager’s hours will vary depending on the case assignment and tasks required.
Establishes relationships and maintains communications with consumers, families, providers, Paradigm’s clients, attorneys (plaintiff and defense), and employers. Ensures that all communication is culturally sensitive and meets requirements to maintain injured worker confidentiality.
Completes accurate and timely system documentation and written reports in accordance with Paradigm documentation standards and best practices.
Represents Paradigm in your role as a case manager by participating in pilot projects, training programs, and quality assurance efforts.
Implements case management plans and coordinates care utilizing appropriate case management interventions. Documents progress towards achievement of case management intervention(s) and evaluates progress on an ongoing basis, modifying the case management plan, if indicated.
Assists sales/marketing team as needed to build caseload. Develops solid relationships with customers in order to ensure repeat business.
Adheres to quality assurance standards and department policies/processes.
Responsible for attending scheduled meetings with manager and attending mandatory staff meetings.
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.
Capability to work outside of traditional business hours (evenings or weekends) to meet business requirements.
Self-motivated and able to work independently.
Other duties as assigned.
Responsible for complying with Paradigm IT security requirements and policies.
Responsible for safeguarding Paradigm or Paradigm related IT passwords.
Responsible for notifying Paradigm of any IT security incidents per policy 16.0 Information Security Incident Management.
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
Current, unencumbered Registered Nurse (RN) license allowing for practice in the United States.
Experience in case management of workers comp cases, preferred.
A national certification (CCM, CRRN, CDMS, or CRC) must be obtained within two years of the date of hire, if not currently held.
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.
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. Responsible for completing all credential renewals prior to the expiration date(s).
Must be skilled at patient education.
Ability to work autonomously with minimal oversight.
Skills required for success: organization and timeline adherence skills, PC and technology skills, communication skills (written, verbal, and interpersonal).
Field Case Managers: 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.
Exceptional ability to reason and learn new processes quickly.
Ability to analyze workflow and make recommendations for changing processes (e.g., simplifying) as appropriate.
Exceptional computer skills including Microsoft Office, PowerPoint, and web-based applications, including case management software. Proficiency with Microsoft Outlook and Teams; SharePoint desired.
Strong clinical skills are required to manage all cases proactively and implement an independent judgement of treatment progress.
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.
Physical Activities: While performing the duties of this job, the employee is regularly required to reach with hands and arms, and to talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand and walk.
Weight Lifted/Force Exerted: The employee's job does not require weight to be lifted greater than 20 pounds.
Vision Requirements: Specific vision abilities required by this job include close vision and the ability to adjust focus.
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.
Telephonic/Home Office Environment: Office environment with office level ambient noise and conditions. While performing the duties of this job, the employee does not work in wet or humid conditions (non-weather), work near moving mechanical parts, work in high, precarious places, endure outdoor weather conditions or endure extreme cold or heat (non-weather). Position may require driving to company related events or meetings.
Noise Level – Will be low to moderate noise found in typical office environments.
Position requires driving of personal or leased automobiles for completion of task. Employee must maintain minimum insurance requirements for coverage. o 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 does not meet carrier standards may have the terms of their employment changed 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.
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Employee (print name) Employee Signature Date