Telephonic Nurse Case Manager

Auto-Owners Insurance • Lansing, MI

4d • Hybrid

About The Position

Auto-Owners Insurance is seeking a nursing professional to provide case management for claimants and support the handling of injury claims. The role uses the case management process to assess, develop, implement, monitor, and evaluate care plans that optimize claimant health across the care continuum. It coordinates support among claimants’ providers, community-based agencies, family, and other support systems, and collaborates with claims associates by providing medical expertise in investigations, evaluations, and resolutions of workers’ compensation, personal injury protection, and liability claims.

The position reviews medical records for injury relatedness and appropriate utilization of treatment and services. It also delivers training to claims staff through written materials, live presentations, WebEx, and telephonic presentations; develops and improves clinical programs and procedures; helps maintain vendor and consultant relationships; and negotiates rates with local healthcare providers. Other duties may be assigned within the clinical team or elsewhere on request.

The role offers a merit-based work-from-home program tied to job responsibilities. After initial in-person training, it may allow work from home up to three days per week.

Requirements

• Active Michigan RN license in good standing.
• Certification in Case Management (CCM), or obtain it within 18 months of hire.
• Three to five years of clinical experience.
• At least three years of experience as a case manager.
• Ability to communicate effectively orally and in writing, read and interpret documents, and write routine reports and correspondence.
• Proficient computer skills, including Microsoft Office products.
• Excellent problem-resolution skills, including analyzing details, making decisions, demonstrating innovativeness, and seeking efficient ways to process and handle work.
• Excellent organizational skills and the ability to manage multiple priorities.
• Ability to work in the U.S. without current or future sponsorship.

Nice To Haves

• Bachelor of Science in Nursing (BSN).
• Insurance Rehabilitation Specialist (CIRS), Disability Management Specialist (CDMS), Rehabilitation Nurse (CRRN), or Occupational Health Nurse (COHN) certification.
• Strong clinical background in orthopedics, neurology, rehabilitation, or trauma care.
• Insurance experience.
• Teaching or training experience.

Responsibilities

• Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize claimant health across the care continuum.
• Coordinate care delivery and support among claimant support systems, including providers, community-based agencies, and family.
• Collaborate with claims associates and provide medical expertise in investigating, evaluating, and resolving workers’ compensation, personal injury protection, and liability injury claims.
• Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services.
• Prepare and deliver training to claims staff through written materials, live presentations, WebEx, and telephonic presentations.
• Identify opportunities and develop and implement new clinical programs, and improve existing programs and procedures.
• Assist in developing and maintaining vendor and consultant expectations and relationships.
• Negotiate rates with local healthcare providers, including nursing homes, sub-acute facilities, and attendant care agencies.
• Assist with other duties in the clinical team department or elsewhere, on request.

Benefits

• Friendly work environment.
• Structured training program.
• Employee mentoring.
• Competitive base salary.
• Matched 401(k).
• Fully funded pension plan once vested.
• Bonus programs.
• Paid holidays, vacation days, personal time, and sick leave.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed