Job Description

Job Description

Job Description

About TRIUNE Health Group

TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs.

At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive—both professionally and personally.

Why Join TRIUNE Health Group as a Nurse Case Manager?

• Be part of a well-established, family-owned company that prioritizes people over profits.
• Experience our culture of People Helping People , where every team member is treated with dignity and respect.
• Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance.

Perks & Benefits:

• Generous Time Off: 20 days of vacation plus 8.5 paid holidays
• Retirement Savings: 401(k) match to help you plan for the future
• Comprehensive Insurance: Medical, dental, and vision coverage
• Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance
• Employee Support: Employee Assistance and Referral Program
• Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor
• Travel Perks: Mileage and travel reimbursement

TRIUNE Health Group is an equal opportunity employer and a values-driven organization. Compensation is competitive and commensurate with experience.

I. Summary of Position :

The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate. Fluency in both Spanish and English is required to effectively communicate with Spanish-speaking patients, providers, and stakeholders.

II. Essential Duties and Responsibilities :

• Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source, in both Spanish and English.
• Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual's progress.
• Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness.
• Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication in both languages.
• Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients' homes when required.
• Communicate medical information clearly and compassionately to Spanish-speaking patients and families.
• Stay current with medical terminology and the federal and state laws related to health care, Workers' Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA.
• Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA.
• Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for Spanish-speaking individuals.
• Possess a valid driver's license with the ability to travel 90% of the time.
• Perform other duties as assigned.

III. Job Qualifications :

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.

Skills and Abilities :

• Proven leadership skills.
• Excellent verbal and written communication skills in both Spanish and English , including the ability to interact effectively with Spanish-speaking patients, customers, and fellow employees via phone, email, in-person, and formal presentations.
• Methodical in accomplishing job-related goals.
• Strong analytical and organizational skills, including the ability to multitask with attention to detail.
• In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet.
• Maintain a friendly, professional attitude at all times.
• Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities.
• Dependability and adaptability.

Education and Experience :

• Graduate of an accredited school of nursing.
• Current RN licensure in the state of operation.
• Fluency in both Spanish and English (speaking, reading, and writing).
• Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology.
• CCM preferred.

Certificates, Licenses, Registrations :

While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS.

IV. 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.

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