Senior Nurse Case Manager - Chicago, Illinois

Emergent Holdings•Lansing, MI

10d•$73,600 - $123,200

About The Position

The Senior Nurse Case Manager (SNCM) works within the Claims Department to support management and the claims team in achieving strategic initiatives and annual claims goals. The position applies medical knowledge to complex workers’ compensation claims, including determining whether symptoms are causally related to reported injuries, assessing treatment necessity and reasonableness, facilitating return to work, and proposing alternative care arrangements. The SNCM also helps develop medical cost-containment programs and projects and leads their implementation and ongoing support. The role may be performed telephonically or as a Field Nurse Case Manager, providing in-person care and coordination. The Field SNCM manages medical care and facilitates return to work for injured employees through on-site, face-to-face interaction with injured workers, providers, and employers. This hybrid field focus supports appropriate and timely care, recovery, and return to work.

Requirements

Active, unrestricted Registered Nurse license.
Five years of progressive responsibility in injury case management, such as workers’ compensation, group health, or auto.
Three years of active patient or clinical experience as a registered nurse.
Knowledge of clinical care and jurisdictional requirements.
Strong negotiation skills and decision-making ability.
Excellent oral and written communication, customer service, report preparation, human relations, negotiation, and decision-making skills.
Proficiency in Microsoft Windows Suite.
Ability to work independently and as part of a team.
Attention to detail and analytical skills.
Demonstrated leadership abilities.
Knowledge of team building and employee motivation, and ability to effectively manage multifunctional employee teams.
Ability to collaborate with and empower others to support team success.
Ability to independently research, plan, develop, and implement corporate projects.
Ability to manage resources, budgets, issues, and risks for successful project completion.
Ability to train others and establish and maintain effective working relationships with internal and external customers.
Strong working knowledge of workers’ compensation laws.
Ability to exercise good judgment in evaluating actions in workers’ compensation claims management.
Ability to read, analyze, and interpret technical, legal, and financial information and procedure manuals.
Ability to make competent, independent decisions and maintain confidentiality where appropriate.
For Field Nurse Case Managers, an unrestricted and valid driver’s license.

Nice To Haves

Bachelor’s degree in nursing (BSN).
Three years of workers’ compensation case management, rehabilitation, insurance, or occupational health experience.
Field Case Manager experience.

Responsibilities

Oversee new assignments and make timely initial contact with all parties.
Review patients’ clinical status and history to assess whether symptoms are causally related to reported work injuries.
Complete RN templates and documentation, including pertinent medical history and exposure analysis covering anticipated treatment, treatment duration, disability duration, and anticipated permanency.
Coordinate with employers to negotiate early return to work or alternative duties based on providers’ reports of employees’ abilities.
Oversee external nurse case management and external RN task assignments; document assignment strategy and anticipated claim cost benefit, and establish a mutually agreed plan of action and completion timeframe.
Apply medical knowledge in contacts with physicians, therapists, and other professionals to assess cases involving prolonged treatment.
Determine the medical necessity and reasonableness of proposed and ongoing treatment, including inpatient or outpatient hospitalization for lost-time cases.
Conduct case research, which may involve contacting or meeting with employees, employers, physicians, medical staff, and medical consultants.
Refer workers’ compensation cases that do not meet medical criteria to the medical director, designated consultant, or independent physician, with supporting case documentation.
Prepare correspondence to research and resolve case disputes and inquiries; contact providers and involve claims representatives as required, and communicate final decisions and resulting implications to claims representatives.
Medically manage claims in multiple jurisdictions.
Close assignments in accordance with internal performance standards.
Train and mentor less experienced nurse case managers.
Prepare professional presentations for prospective customers.
Assist the manager with monthly NCM outcomes, reports, and quality assessment evaluations of Nurse Case Managers as needed.
For field assignments, travel and conduct on-site, face-to-face interactions with injured workers, providers, and employers to coordinate care and return to work.