Nurse Case Manager

SFM - The Work Comp Experts•Bloomington, MN

1d•$74,500 - $104,295•Hybrid

About The Position

At SFM, doing the right thing guides the work and gives employees the opportunity to make a difference in people’s lives. The Nurse Case Manager serves as a medical resource and educator while managing the medical side of workers’ compensation claims. Working primarily by phone, the role provides high-quality service to injured workers and policyholders, promotes safe and timely return to work, and partners with claims representatives as part of a multidisciplinary Business Team. The position applies medical expertise to resolve medical and claim issues cost-effectively and promotes case management consistent with medical best practices and applicable state laws and regulations. Excellent customer service to everyone involved in the claims process is central to the role. The ideal candidate lives in Minnesota, in or near the Twin Cities area; candidates with occupational health experience are encouraged to apply. The role provides telephonic medical case management, including assessment, care planning, and service coordination, with the goal of facilitating return to work and reaching end of healing or maximum medical improvement in a timely, high-quality, cost-effective manner. The Nurse Case Manager may meet with injured workers, policyholders, and medical providers in person or virtually, and documents initial and ongoing assessments in claim files so internal customers can follow case management and return-to-work progress and support timely claim closure. The position works with providers and policyholders to establish return-to-work plans based on guidelines, medical data, available resources, and the injured worker’s functional abilities. It educates internal and external customers about general healing, injury-specific health information, disability duration, and medical treatment parameters, using appropriate state and national resources and best practices. The role also provides clinical guidance to the claims team concerning treatment appropriateness and timing, cost containment, and return-to-work strategies; identifies and coordinates appropriate resources; participates in multidisciplinary claim discussions as needed; and responds promptly to complaints or problems. Work is performed in a semi-paperless office environment, either on business premises or from another remote location, using standard office equipment. The position is hybrid and based in Bloomington, Minnesota. The role requires regular attendance and extended periods of being stationary, with indoor work and little to no exposure to extreme outdoor weather conditions.

Requirements

Associate’s degree and current RN licensure in the state hired.
Two years of relevant experience, such as case management, physical rehabilitation, or occupational health.
Ability to evaluate ongoing treatment and return-to-work potential within established protocols and adjust case management strategies as warranted.
Strong knowledge of medical treatment protocols and physician advisor utilization.
Effective organizational skills, including the ability to manage multiple projects and work with minimal direction.
Excellent customer service and interpersonal skills.

Nice To Haves

Bachelor’s degree preferred.
Multi-state licensure preferred.
Workers’ compensation or casualty insurance experience preferred.
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), or Certified Rehabilitation Registered Nurse (CRRN) designation preferred.
Five years of clinical experience preferred.
Occupational health experience is encouraged.

Responsibilities

Provide telephonic medical case management for workers’ compensation claims, including assessment, care planning, and coordination of services to facilitate return to work and timely end of healing or maximum medical improvement.
Meet with injured workers, policyholders, and medical providers in person or virtually to support positive outcomes.
Document initial and ongoing assessments in claim files and keep internal customers informed of case management and return-to-work progress.
Develop proactive return-to-work plans with providers and policyholders using guidelines, medical data, resources, and the injured worker’s functional abilities.
Educate internal and external customers on healing, injury-specific health information, disability duration, and medical treatment parameters using appropriate state and national resources and best practices.
Provide clinical guidance and recommendations to the claims team regarding medical treatment appropriateness and timing, cost containment, and return-to-work strategies.
Identify and coordinate resources including physician advisor reviews, second opinions, independent medical examinations, ergonomic evaluations, job analyses, discharge planning, durable medical equipment, and home health services.
Participate in multidisciplinary claim discussions as needed.
Provide excellent customer service, comply with customer service standards, and respond promptly to complaints or problems.