Nurse Case Manager

Position Summary:

 

Supports the claims adjuster's management of files through application of medical expertise and case management principles by coordinating quality medical treatment and services in a cost-effective manner with a focus on early, safe return to work.

 



Duties and Responsibilities:

 

§  Initiates injured worker, attorney, medical provider and employer contacts within protocols.

§  Obtains necessary information for purposes of developing an appropriate treatment plan and facilitating case progression.

§  Authorizes cost-effective treatment appropriate for claim.

§  Develops, implements and evaluates medical and disability plan and initiates appropriate and timely case management interventions.

§  Coordinates services and resources necessary to expedite a full recovery and early return to work.

§  Reviews claims with adjuster, providing medical and vocational recommendations, i.e., IME, FCE, medical intervention and vocational services, with emphasis on moving claim to closure.

§  Utilizes and monitors preferred vendors for select services to ensure prompt, cost effective service.

§  Follows established utilization review policy and protocol.

§  Provides support to claimant and family during case management phase and documents all case management activity

§  Provides catastrophic phone coverage when necessary to help assess appropriate resources needed for claims and medical management.

§  Acts as medical resource to peers, claims and legal personnel.

§  Supports Health Services Departments to ensure optimal service delivery.

§  Participates in Medicare Set-Asides and reserving activities per established policy and procedure.

 



Skills, Education and Experience:

 

§  BSN preferred, experience in lieu of degree accepted.

§  Maryland RN License required.

§  Case management/ Utilization review experience preferred.

§  Current WCCM and MCRSP certification.

§  CCM is preferred.

§  Current WCCM and MCRSP certification.

§  Prior workers’ compensation case management experience.

§  Two years of active nursing experience in orthopedic, medical/surgery, emergency room, intensive care, or occupational medicine is preferred.

§  Strong interpersonal skills.

§  PC skills – Windows, Word, Excel

§  Bilingual skills preferred.