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Nurse Medical Case Manager - Workers Compensation - Rancho Cordova, CA
VetJobs, Rancho Cordova, California, us, 95741
Nurse Medical Case Manager - Workers Compensation - Rancho Cordova, CA
Join to apply for the
Nurse Medical Case Manager - Workers Compensation - Rancho Cordova, CA
role at
VetJobs . Job Description Under moderate supervision, provide office-based telephonic medical case management focusing on early intervention, return to work planning, and coordination of quality medical care on claims involving disability and medical treatment. Responsible for ensuring injured parties receive appropriate treatment related to the injury and assisting claim handlers in managing medical treatment to resolution. Responsibilities include: Contact customers, medical providers, and injured parties to coordinate medical care and return to work. Develop and evaluate strategies for injured employee's return to work and medical improvement. Coordinate with medical providers to ensure active participation in treatment plans. Evaluate medical treatment requests for reasonableness and necessity. Engage specialty resources as needed to resolve claims effectively. Partner with Claim Professionals to provide medical information and disability status. Utilize internal systems to manage claim activities timely. Participate in file reviews and respond to inquiries. Keep injured workers informed about claim status. Perform in-person medical case management if required. Note: Acquisition and maintenance of insurance licenses and certifications may be required within three months. Qualifications: Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse. Disability Case Management experience preferred. Familiarity with URAC standards, insurance contracts, investigation principles, and medical knowledge. Strong communication, negotiation, analytical, and organizational skills. Certifications such as CCM, CDMS, CRC, or CRRN are preferred. Compensation:
$75,000 - $100,000 annually, with potential performance incentives. Location:
Rancho Cordova, CA. Employment Type:
Full-time, Entry level.
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Join to apply for the
Nurse Medical Case Manager - Workers Compensation - Rancho Cordova, CA
role at
VetJobs . Job Description Under moderate supervision, provide office-based telephonic medical case management focusing on early intervention, return to work planning, and coordination of quality medical care on claims involving disability and medical treatment. Responsible for ensuring injured parties receive appropriate treatment related to the injury and assisting claim handlers in managing medical treatment to resolution. Responsibilities include: Contact customers, medical providers, and injured parties to coordinate medical care and return to work. Develop and evaluate strategies for injured employee's return to work and medical improvement. Coordinate with medical providers to ensure active participation in treatment plans. Evaluate medical treatment requests for reasonableness and necessity. Engage specialty resources as needed to resolve claims effectively. Partner with Claim Professionals to provide medical information and disability status. Utilize internal systems to manage claim activities timely. Participate in file reviews and respond to inquiries. Keep injured workers informed about claim status. Perform in-person medical case management if required. Note: Acquisition and maintenance of insurance licenses and certifications may be required within three months. Qualifications: Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse. Disability Case Management experience preferred. Familiarity with URAC standards, insurance contracts, investigation principles, and medical knowledge. Strong communication, negotiation, analytical, and organizational skills. Certifications such as CCM, CDMS, CRC, or CRRN are preferred. Compensation:
$75,000 - $100,000 annually, with potential performance incentives. Location:
Rancho Cordova, CA. Employment Type:
Full-time, Entry level.
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