Senior Nurse Case Manager

MEM•Olathe, KS

14d•Onsite

About The Position

MEM Insurance is seeking a dedicated Nurse Case Manager to help injured workers navigate their recovery journey while supporting safe and timely return-to-work outcomes. In this role, you will serve as a trusted partner between injured workers, healthcare providers, employers, and claims professionals. You will coordinate medical treatment plans, monitor recovery progress, identify barriers to successful rehabilitation, and advocate for appropriate care within the workers' compensation system. Through regular communication and relationship building, you will help ensure injured workers receive quality, cost-effective healthcare while promoting the best possible recovery outcomes. This position is primarily an on-site regional role with regular interaction with injured workers, medical providers, employers, and internal stakeholders.

Requirements

Associate Degree in Nursing or completion of a Diploma Registered Nurse Program required.
Active Registered Nurse (RN) designation required.
3+ years of clinical nursing experience in Medical/Surgical settings required.

Nice To Haves

Certification in Case Management through the Case Management Society of America (CMSA) preferred.
5+ years of insurance or workers' compensation case management experience preferred.

Responsibilities

Coordinate and manage medical treatment plans for injured workers throughout the life of the claim.
Serve as a liaison among injured workers, healthcare providers, employers, therapists, and claims professionals to ensure effective communication and care coordination.
Assess medical information and treatment progress to identify opportunities that support recovery and safe return-to-work outcomes.
Evaluate return-to-work potential by considering medical status, job demands, vocational history, educational background, and other relevant factors.
Develop individualized case management strategies that promote quality care and positive rehabilitation outcomes.
Advocate for appropriate medical treatment and identify gaps or barriers that may impact recovery within the workers' compensation system.
Gather and maintain critical case information, including job descriptions, medical history details, treatment documentation, and related records.
Conduct ongoing telephonic and remote case management activities, including follow-up calls, provider communication, email correspondence, and documentation.
Maintain accurate, timely, and confidential case records and documentation within company systems.
Review medical files and treatment plans to provide recommendations and support quality care decisions.
Ensure compliance with applicable regulations, company policies, confidentiality requirements, and documentation standards.
Monitor case progress and communicate updates regularly with leadership, claims professionals, employers, and medical providers.
Maintain an active caseload and prioritize activities to effectively manage competing responsibilities and deliver exceptional service.
Participate in ongoing professional development to maintain current knowledge of healthcare trends, workers' compensation practices, regulations, and industry best practices.