Field RN Case Manager - Workers' Compensation

NJM Insurance Group • Trenton, NJ

21h • $84,610 - $98,261

About The Position

Reporting directly to the Medical Management Supervisor, the Workers' Compensation (WC) Case Manager supports the WC Department by following the best practices associated with managing of the injured worker effectively and efficiently. The position requires the nurse to work and communicate with other members of the Medical Management team in addition to the WC Claims team, WC Claims Supervisors, and other team members. The WC Team Lead also interacts with the associated injured parties or their legal representatives, medical providers, and other departments within NJM, as needed. The official NJM job title is Medical Management Coordinator. Essential Duties and Responsibilities: Demonstrate knowledge, skills, and competency in the application of case management standards of practice. Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs. Facilitate the Injured Worker’s rehabilitation by coordinating medical treatment, advocate for the Injured Worker with all medical providers and stakeholders and educate the Injured Worker on their recovery process. Understand, apply, and comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review, case management, and medical management. Attend on-site visits with Injured Worker, physicians and other treatment providers, when necessary. Evaluate the appropriateness, medical need and efficiency of health care procedures and facilities according to established criteria or guidelines. Effectively communicate and collaborate with management, peers, and colleagues to ensure alignment, compliance and effective management of assigned claims. Participate and/or support identified project initiatives Proactively seek development opportunities and identify business process improvements to maximize effectiveness of operations and minimize cost.

Requirements

• RN required
• 5 years of clinical nursing experience required
• Ability to travel within State of NJ/assigned territory dependent on business needs.
• Strong internal and external relationship management skills
• Detail oriented with exceptional time management and organizational skills.
• Ability to work independently and in a team environment
• Proactive
• Willingness to learn and grow within the position
• Demonstrate reliability and conform to the company’s attendance policy
• Intermediate Microsoft Office Suite skills (Outlook, Word, Excel, PowerPoint) with ability to navigate technology and multiple systems effortlessly.

Nice To Haves

• WC/PIP experience preferred
• Bachelor of Science in Nursing (BSN) is preferred.
• Certified Case Manager (CCM) beneficial.

Responsibilities

• Demonstrate knowledge, skills, and competency in the application of case management standards of practice.
• Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs.
• Facilitate the Injured Worker’s rehabilitation by coordinating medical treatment, advocate for the Injured Worker with all medical providers and stakeholders and educate the Injured Worker on their recovery process.
• Understand, apply, and comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review, case management, and medical management.
• Attend on-site visits with Injured Worker, physicians and other treatment providers, when necessary.
• Evaluate the appropriateness, medical need and efficiency of health care procedures and facilities according to established criteria or guidelines.
• Effectively communicate and collaborate with management, peers, and colleagues to ensure alignment, compliance and effective management of assigned claims.
• Participate and/or support identified project initiatives
• Proactively seek development opportunities and identify business process improvements to maximize effectiveness of operations and minimize cost.

Benefits

• Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level