Supervisor, Telephonic Nurse Case Manager

ICW Group•San Diego, CA

1d•Hybrid

About The Position

At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! The purpose of the Supervisor, Telephonic Nurse Case Management position is to supervise a team of Nurse Case Managers and to perform clinical assessment and evaluate needs for treatment in worker’s compensation claims. The Supervisor will ensure the proper negotiation and coordination of appropriate medical treatment and length of disability with providers and employers while managing financial and other claims related risk on behalf of the Company.

Requirements

Associate's degree in Nursing required.
Minimum 5-7 years of professional experience providing direct clinical care required.
Current unrestricted Registered Nurse (RN) required.
Working knowledge of direct clinical care required.
Ability to work with medical and mathematical concepts such as diagnoses, probability and statistical inference.
Ability to compute mathematical frequency and percentages.
Ability to apply principles of logical, sounds judgement or medical thinking to a wide range of intellectual and practical problems.
Ability to combine disparate skills and thinking to craft solutions to moderate to complex problems.
Ability to hypothesize on root cause of inefficiencies in treatment and then articulate probable solutions.
Ability to read, analyze, and interpret documents such as medical reports and health information of all types, industry journals, and legal documents.
Ability to respond to common inquiries or complaints from customers, regulatory agencies, injured workers and members of the business community.
Must be able to read, write and speak English effectively.
Ability to effectively present information to ICW staff, and external audiences.

Nice To Haves

Bachelor’s degree from four-year college or university in nursing (BSN) preferred.
Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.

Responsibilities

Oversees worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
Performs and supervises initial and ongoing clinical assessment via telephone calls to the injured worker, employer, physician and attorney.
Assesses client's situation for psychosocial needs, cultural implications and ensures support systems in place.
Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
Builds and maintains audit tools and processes in the assigned areas of the department and conducts monthly case reviews with team members.
Audits team member case files and provides feedback and improvement recommendations on open and closed claims.
Monitors ongoing progress toward established goals and objectives.
Implements plan through case management interventions and communication with all parties to reach desired goals and objectives.
Strategizes and implements effective treatment plans and creates alternate strategies when needed.
Reviews case files and recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
Ensures team is negotiating appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
Supervises and reports on return to work of injured workers and supplies detailed return to work plans regularly.
Measures and reports on interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction.
Maintains accurate record of management including costs, savings and demographic data.
Communicates effectively with all parties involved in injured worker’s treatment and establishes communication standards.
Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery per policy.
Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.
Ensures processes are in place for team members to effectively maintain and protect injured worker's privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards.
Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
Performs and supervises Utilization Review activities and reviews timely reports with clients and providers.
Develops and leads a team of Nurse Case Managers.
Organizes team workloads, assigns projects and manages resources and results.
Sets performance expectations, team and individual goals and timelines in alignment with Department goals.
Provides regular feedback and coaching to team members.
Mentors and develops team members to further their skills and knowledge; creates and monitors development plans.
Prepares and conducts performance evaluations.
Hires and develops employee, and prepares disciplinary actions (including terminations).
Approves direct report’s expense reports and expenses beyond their authority.
Establishes and maintains the overall work cadence and, in partnership with Worker’s Compensation Claims leaders, ensures performance and outcomes strive for excellence in delivery and customer experience.
Oversees the performance management and development process for direct reports and performs performance management duties, development planning and coaching.
Ensures that direct reports are engaged and that leadership practices in the department encourage development, recognition and retention.
Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations/goals; forecasting staffing needs and planning for peak times and absences; enforcing department policies and procedures.