Nurse Case Manager

Encova Insurance

8d•$55,132 - $110,642•Remote

About The Position

The Nurse Case Manager serves as an office-based skilled medical resource for the business teams. The position’s objective is to provide high quality customer service in medical case management and utilization review, primarily telephonically. The Nurse Case Manager provides medical expertise and serves a critical role in the cost containment of medical and indemnity expenses.

Requirements

Licensed Registered Nurse with no restrictions.
Minimum of an Associate degree in nursing from an accredited college or university or successful completion of a diploma nursing program required. Bachelor’s or Master’s degree in nursing preferred.
One year of experience in nurse case management, medical case management, utilization review, vocational/disability case management required.
Nationally recognized specialty certification in occupational or rehabilitative nursing or case management must be obtained as applicable, such as Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Registered Rehabilitation Nurse (CRRN), or Certified Occupational Health Nurse (COHN). National certification may substitute for one year of experience requirement.
Two years of clinical experience in orthopedics, neurology, rehabilitation, internal medicine, or occupational medicine is required.
Ability to collect relevant information, establish facts, and draw relevant conclusions, and recommend effective solutions.
Working knowledge of evidence-based treatment guidelines, treatment protocols, medical causation and relatedness.
Ability to efficiently coordinate effective medical treatment while maximizing cost containment.
Ability to effectively collaborate with multiple team members and stakeholders.
Strong planning and organizing skills.
Working knowledge of the theory, principles, and practices of medical case management.
Ability to maintain knowledge of current trends and developments in the medical case management field.
Excellent oral and written communication skills.
Demonstrate diplomacy, compassion and professional competency.
Competent in Word, Outlook and Excel and capable of assimilating new systems applications and technology.
Ability to work effectively in a paperless environment.

Nice To Haves

Multi-state case management experience is desired.
Bilingual ability is a plus.

Responsibilities

Complete early medical management assessment and intervention on claims requiring medical treatment. Contact injured workers and medical providers to obtain necessary information.
Apply knowledge, experience and evidence-based guidelines to evaluate claims and provide a proactive action plan.
Perform essential medical case management activities assessment, planning, implementation, monitoring and evaluation within accepted treatment guidelines.
Address medical cost containment through utilization management, collaboration with providers and assessing network resources.
Partner with appropriate team members to expedite injured worker recovery and return to work and to reduce disability costs.
Identify and monitor claims for task assignments to field case managers.
Evaluate accuracy of diagnoses of injuries or disabilities.
Document recommendations, contacts, actions and outcomes.
Adhere to jurisdictional regulations and standards.
Provide high quality customer service within a team-based environment.
Non-essential function: other duties as assigned.