Telephonic Nurse Case Manager

ICW Group • Pleasanton, CA

1d • Hybrid

About The Position

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? 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! Learn more about why you want to be here! PURPOSE OF THE JOB The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker’s compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risks on behalf of the Company.

Requirements

• Associate's or Bachelor’s degree from four-year college or university in Nursing preferred. Equivalent combination of education and experience may be considered.
• Minimum 2 years of professional experience providing direct clinical care required.
• Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required.
• Working knowledge in 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

• Case Management in WC, Discharge Planning, or Home Health preferred.
• Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.

Responsibilities

• Creates and manages worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.
• Performs initial and ongoing clinical assessment via telephone calls to relevant parties that may include the injured worker, physician, attorney or other parties .
• Assesses client's situation for psychosocial needs, cultural implications and ensures support systems are in place.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• 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.
• Measures effectiveness of treatment plans and creates alternate strategies when needed.
• Recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
• Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
• Negotiates and coordinates a prompt return to work with employer.
• 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.
• Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
• Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.
• Maintains 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.
• May perform Utilization Review activities (or review information coming through a vendor partner); presents reports to clients and providers .

Benefits

• Challenging work and the ability to make a difference
• You will have a voice and feel a sense of belonging
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
• Bonus potential for all positions
• Paid Time Off
• Paid holidays throughout the calendar year
• Want to continue learning? We’ll support you 100%

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree