Nurse Case Manager

SFM Mutual Insurance Companies•Bloomington, MN

12h•Hybrid

About The Position

At SFM, doing the right thing guides the company’s 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, helping manage workers’ compensation claims. Working primarily by phone, this role provides high-quality service to injured workers and policyholders, manages the medical side of each claim, and promotes a safe, timely return to work. The Nurse Case Manager partners with claims representatives in a multidisciplinary Business Team, applying medical expertise to resolve medical and claim issues cost-effectively. The role promotes case management consistent with medical best-practice guidelines and state laws and regulations, with excellent customer service to everyone involved in the claims process central to SFM’s mission. The position provides telephonic medical case management, including assessment, care planning, and coordination of services to support return to work and timely achievement of end of healing or maximum medical improvement. The Nurse Case Manager meets with injured workers, policyholders, and medical providers in person or virtually; documents case progress; develops return-to-work plans; provides medical education; and advises the claims team on treatment, cost containment, and return-to-work strategies. The role also identifies and coordinates clinical and vocational resources and participates in multidisciplinary claim discussions. The position is full-time and hybrid, based in Bloomington, Minnesota. SFM indicates that the ideal candidate lives in Minnesota, in or near the Twin Cities area. The work takes place in a semi-paperless office environment, on business premises or at another remote location, using standard office equipment. SFM is a workers’ compensation insurer and an Equal Opportunity/Affirmative Action Employer.

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

Responsibilities

Provide telephonic medical case management for workers’ compensation claims, including assessment, care planning, and coordination of services to facilitate return to work and achieve end of healing or maximum medical improvement in a timely, high-quality, and cost-effective manner.
Meet with injured workers, policyholders, and medical providers, in person or virtually, to support the best possible outcomes.
Document initial and ongoing assessments in claim files to keep internal customers informed about case management and return-to-work progress and support timely claim closure.
Use proactive return-to-work strategies, working with providers and policyholders to establish plans based on guidelines, medical data, resources, and injured workers’ functional abilities.
Provide education and medical treatment parameter information about general healing, injury-specific health information, and disability duration, using appropriate state and national resources and following best practices.
Provide clinical guidance and recommendations to the claims team on 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 premier customer service and comply with customer service standards.
Respond promptly to resolve complaints or problems.