Manager, Medical Case Management

AmTrust Financial Services, Inc.•Nashua, NH

5d•$92,000 - $12,000

About The Position

The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker’s compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years’ experience overseeing a nursing claims management program as well as in-depth understanding of worker’s compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical treatment and engagement of the injured worker to achieve a safe and reasonable return to work. This position requires interaction with physicians, other medical providers, claims professionals, supervision, injured employees and employers.

Requirements

Ability to develop, manage and direct an office/unit operation and effectively communicate operational procedures to field/unit staff.
Demonstrated leadership and innovation in achieving results.
Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies.
Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required.
National Certification in case management OR the ability to obtain certification within 24 months of employment is required.
Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management.
Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitationKnowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies

Nice To Haves

Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
Written and verbal fluency in Spanish and English preferred.
Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience.

Responsibilities

Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers.
Responsible for all oversight of operational and administrative activities within the department/unit.
Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded.
Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff.
Management of performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions.
Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations.
Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level.
Ensures appropriate compliance with all legislation, corporate policies, and programs.
Assist Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews.
Implements new and revised policies and procedures.
Performs additional duties and/or is assigned special projects as requested.