VetJobs
Nurse Medical Case Manager - Workers Compensation-West Bridgewater, MA
VetJobs, West Bridgewater, Massachusetts, us, 02379
Overview
Nurse Medical Case Manager - Workers Compensation - West Bridgewater, MA
Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
What Will You Do?
Contact customer, medical provider and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
Utilize Preferred Provider Network per jurisdictional guidelines.
Submit accurate billing documentation on all activities as outlined in established guidelines.
Customer engagement; participate in telephonic and/or onsite file reviews; respond to inquiries (oral and written); keep injured worker apprised of claim status.
In-person medical case management may be required to support Concierge locations, where a nurse case manager meets with injured employees face to face following office visits at a provider's medical facility.
Acquisition and maintenance of insurance license(s) and/or certifications may be required to comply with state and Travelers requirements; licenses are generally expected to be obtained within three months.
Perform other duties as assigned.
Qualifications
Minimum Education Required: Bachelors
Must Have: Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse (RN/LPN/LVN)
Licensing: Licensed RN/LPN/LVN; licenses to be obtained within three months where required.
Disability Case Management Experience Preferred; Prior clinical experience preferred; Familiarity with URAC standards.
WC Technical: intermediate ability to demonstrate understanding of WC products and apply resources and technology to manage treatment plans and assist with claim resolution; ability to work within jurisdictional parameters.
Medical knowledge: thorough knowledge of the nature and extent of injuries, disability periods, and treatment needed.
Legal Knowledge/General Insurance Contract Knowledge: basic knowledge and application as relevant to the insurance industry.
Certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.
Analytical Thinking; Communication; Negotiation; Customer Service; Teamwork; Planning & Organizing – as described in job requirements.
Job Details
Location: West Bridgewater, Massachusetts
Affiliate Sponsor: Travelers Insurance
Seniority level: Entry level
Employment type: Full-time
Job function: Health Care Provider
Salary Range: $83,300.00 - $137,400.00
Salary Range: $75,000 - $100,000
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Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
What Will You Do?
Contact customer, medical provider and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
Utilize Preferred Provider Network per jurisdictional guidelines.
Submit accurate billing documentation on all activities as outlined in established guidelines.
Customer engagement; participate in telephonic and/or onsite file reviews; respond to inquiries (oral and written); keep injured worker apprised of claim status.
In-person medical case management may be required to support Concierge locations, where a nurse case manager meets with injured employees face to face following office visits at a provider's medical facility.
Acquisition and maintenance of insurance license(s) and/or certifications may be required to comply with state and Travelers requirements; licenses are generally expected to be obtained within three months.
Perform other duties as assigned.
Qualifications
Minimum Education Required: Bachelors
Must Have: Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse (RN/LPN/LVN)
Licensing: Licensed RN/LPN/LVN; licenses to be obtained within three months where required.
Disability Case Management Experience Preferred; Prior clinical experience preferred; Familiarity with URAC standards.
WC Technical: intermediate ability to demonstrate understanding of WC products and apply resources and technology to manage treatment plans and assist with claim resolution; ability to work within jurisdictional parameters.
Medical knowledge: thorough knowledge of the nature and extent of injuries, disability periods, and treatment needed.
Legal Knowledge/General Insurance Contract Knowledge: basic knowledge and application as relevant to the insurance industry.
Certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.
Analytical Thinking; Communication; Negotiation; Customer Service; Teamwork; Planning & Organizing – as described in job requirements.
Job Details
Location: West Bridgewater, Massachusetts
Affiliate Sponsor: Travelers Insurance
Seniority level: Entry level
Employment type: Full-time
Job function: Health Care Provider
Salary Range: $83,300.00 - $137,400.00
Salary Range: $75,000 - $100,000
#J-18808-Ljbffr