Nurse Case Manager
Chesapeake Employers Insurance•Towson, MD
•Onsite
About The Position
Supports the claims adjuster's management of files through application of medical expertise and case management principles by coordinating medically necessary and cost-effective medical treatment and services with a focus on an early and safe return to work.
Requirements
- Maryland RN License required.
- 3-5 years' experience in nursing.
- Familiarity with Windows, Word and Excel.
- Strong interpersonal skills.
Nice To Haves
- Bachelor's Degree (BSN) preferred.
- Case management/utilization review experience preferred.
- Prior workers' compensation case management experience preferred.
- Workers Compensation Case Management (WCCM) and Maryland Certified Rehabilitation Service Practitioner (MCRSP) certification preferred.
- Certified Case Manager (CCM) preferred.
Responsibilities
- Initiates injured worker, attorney, health care provider and employer contacts within protocols.
- Develops, implements and manages the medical and disability plans, and initiates appropriate and timely case management interventions.
- Implements and coordinates services with the injured worker, family and health care providers during case management phase and documents all case management activity.
- Obtains necessary information for purposes of facilitating the treatment plan and managing case progression.
- Authorizes medically necessary, evidence-based and cost-effective treatment.
- Coordinates services and resources necessary to expedite return to work.
- Acts as a resource by review of claims with all relevant parties, such as Claims, Health Services and Legal.
- Utilizes and monitors preferred vendors for select services to ensure prompt, cost effective service.
- Follows established precertification and utilization review policies and protocols.
- Acts as medical resource to peers, claims and legal personnel.
- Supports Health Services Departments to ensure optimal service delivery to all customers.
- Provides specialized case management services such as catastrophic case management or similar type roles.
- Pursues and participates in continual educational activities for self-development and in meeting all regulatory requirements.
- Responsible for delivery of customer service, exceeding expectations.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
