Catastrophic Telephonic Nurse Case Manager

Great American Insurance Company•Lakeland, FL

15d•Hybrid

About The Position

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic. Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities. Our field team members are located in every state in which we operate. Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best. This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship. Essential Job Functions and Responsibilities * Manage claims involving severe traumatic injuries, spinal cord injuries, traumatic brain injuries, amputations, severe burns, polytrauma, and other catastrophic conditions. * Monitors, coordinates, and evaluates complex and catastrophic workers' compensation claims to ensure appropriate, effective, and cost-efficient medical care. * Identify current and anticipated medical needs, including hospitalization, rehabilitation, durable medical equipment (DME), home health services, attendant care, and specialty treatment. * Coordinates medical services with physicians, specialists, rehabilitation providers, hospitals, home health agencies, and ancillary vendors to facilitate continuity of care. * Identifies barriers to recovery, treatment compliance, and return-to-work progression and develops appropriate action plans to address them. * Serves as a clinical resource to claims professionals, employers, providers, injured workers, and other stakeholders by providing recommendations regarding medical treatment, prognosis, and disability management. * Maintains accurate and timely documentation, clinical summaries, recommendations, and claim notes while ensuring compliance with workers' compensation regulations, nursing standards, and company policies. * Evaluate requests for field case management and other specialized medical management services. * Performs other duties as assigned. The individual selected for this role will be based in one of our three office locations: Baton Rouge, LA; Gainesville, GA; or Lakeland, FL. These offices provide a hybrid work model, consisting of 4 days in the office and 1 day working remotely. For candidates located outside this region, full-time remote may be considered in current operating states, although some travel will be necessary. #LI-Hybrid

Requirements

Associate Degree in Nursing required.
Current unrestricted Registered Nurse (RN) license required.
Minimum of 5 years of direct clinical nursing experience required, preferably in acute care, trauma, critical care, rehabilitation, or a related specialty.
Extensive knowledge of workers' compensation medical management principles, evidence-based treatment guidelines, and disability management practices.
Strong ability to assess complex medical conditions, analyze medical records, identify barriers to recovery, and develop effective case management strategies.
Excellent organizational, written, verbal, and interpersonal communication skills.
Ability to collaborate with multidisciplinary teams and manage multiple priorities while maintaining confidentiality.
Demonstrated proficiency with claims management systems, electronic medical records, and Microsoft Office applications.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Compact RN licensure preferred.
Preferred 3-5 years of catastrophic workers' compensation case management experience with a demonstrated ability to manage complex, high-exposure claims from initial referral through claim resolution.
Experience navigating workers' compensation regulations, medical management practices, treatment guidelines, utilization review processes, and return-to-work programs across multiple state jurisdictions is strongly preferred.
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Registered Nurse (CRRN), or equivalent case management certification.

Responsibilities

Manage claims involving severe traumatic injuries, spinal cord injuries, traumatic brain injuries, amputations, severe burns, polytrauma, and other catastrophic conditions.
Monitors, coordinates, and evaluates complex and catastrophic workers' compensation claims to ensure appropriate, effective, and cost-efficient medical care.
Identify current and anticipated medical needs, including hospitalization, rehabilitation, durable medical equipment (DME), home health services, attendant care, and specialty treatment.
Coordinates medical services with physicians, specialists, rehabilitation providers, hospitals, home health agencies, and ancillary vendors to facilitate continuity of care.
Identifies barriers to recovery, treatment compliance, and return-to-work progression and develops appropriate action plans to address them.
Serves as a clinical resource to claims professionals, employers, providers, injured workers, and other stakeholders by providing recommendations regarding medical treatment, prognosis, and disability management.
Maintains accurate and timely documentation, clinical summaries, recommendations, and claim notes while ensuring compliance with workers' compensation regulations, nursing standards, and company policies.
Evaluate requests for field case management and other specialized medical management services.
Performs other duties as assigned.