Case Management Supervisor
Tower Group Companies - Chicago, IL

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· Nurse Case Management/Supervision:

· Develop and supervise Nurse Case Management utilization strategy · Supervise and manage the daily activities of Tower field office Nurse Case Managers. Responsibilities include but are not limited to: § Interview and hire NCMs according to Tower requirements § Educate NCMs as to job duties and expectations, including Tower Workers Compensation and Medical Management ‘Best Practices’ § Implement field office ‘case assignment’ process for on-site NCMs, and oversee daily assignments § Develop statistical and ad hoc reports to monitor outcomes of Nurse Case Management Unit. Analyze for trends. Share results with LOB and Claims Executive Management Team § Implement Medical Management Best Practice Quality Reviews for each NCM, on a quarterly basis, to evaluate overall performance. § Implement time and expense billing practices for the unit in accordance with Corporate direction · Program Management: · Oversee vendor programs for the Managed Care Services, at the direction of the Director of Managed Care Services: § On-site Nurse Case Management Services § On-site Catastrophic Case Management Services § Utilization Review Services § Peer Review Services § Outside use of Field Case Management vendors § Use of Independent Medical Examinations § Catastrophic Case Management services (referred and internal) · Develop reports to evaluate the quality and outcomes of the above mentioned services. Analyze for trends. Distribute to Executive Management at the direction of the Managed Care Services Manager. · Resolve any quality issues with external vendors providing the above listed services. · Certify additional regional and/or national providers of the above mentioned services for inclusion onto the Tower Managed Care Services Preferred Provider list, as necessary. · Provide monthly statistical analysis of the internal and external program(s) to management. · Prepare and present quarterly internal stewardship reports to claims management staff and other Tower Group stakeholders · Provide additional analysis of program as requested · Consult with management team on industry trends ¨ Oversight of Medical Management Support: · supervise team in provision of medical expertise and direction to Claims Examiners as needed/requested on catastriophic workers' compensation claims. · Establish Roundtable / Committee catastrophic and/or medically complex files with adjusters, field Management, and Defense Counsel and a workflow for each claims office. · Provide input on the appropriate medical specialists for adjusters as necessary, including but not limited to · Treating physicians · Network providers · Specialist physicians · Ancillary service providers · IME specialists · Peer review specialists ¨ Oversight of Training and Education relative to medical management: · As guided by Director of Managed Care Services and/or LOB AVP, develop training programs to meet identified developmental needs, and deliver as required · Participate with Managed Care Director, Technical Manager, and LOB AVP in identifying Enterprise wide LOB training and development opportunities, and assuring appropriate training and development plans are put in place to address those needs. Participate in Training Council as needed. · Supervise the assigned Field Nurse Case Manager; in the provision of educational support to field office personnel: § Train and individual staff on an ongoing basis as opportunities present themselves. Educate Claims Examiners and/or clients on the definitions of diagnoses, mechanisms of injury, treatment plans, and approved industry medical standards. § Identify office level training needs regarding medical management knowledge and skils, and assure appropriate plans are put in place in partnership with the Field Office Management Team to address those needs § Coordinate on-site continuing education opporutities with industry specialists related to specific medical management topics · Keep current and continue to develop your personal knowledge and skill level as it pertains to medical management topics, completing necessary CEU course as required to maintain license/certification ¨ Cost Containment · Mitigate Medical and Disability Loss cost exposures on claims within your assigned authority through the implementation of appropriate medical resolution strategies and tools · Measure and analyze effectiveness of utilization review and precertification process · Evaluate physician referral patterns and recommend alternatives for improvement · Identify and isolate injury types and treatment patterns that drive loss costs, and develop strategies to improve · Record time and expense as required and directed, on a case by case basis. Comply with Corporate time and billing policies. · Track and report on the overall effectiveness of all cost containment efforts that the field nurses and outside case managers are involved in. ¨ Projects · Completion of any and all additional projects as assigned by the Director of Managed Care.

¨ Education · Degree in Nursing, Healthcare,Occupational Medicine or other related field. ¨ Experience · 5 – 7 years of Managed Care Services Industry experience required. Specific to workers’ compensation strongly preferred. · 2-5 years Nurse Case Management program Supervisory/Management. · Experience in Managed Care Services oversight and/or implementation within the Commercial and/or Personal Insurance Industry · Experience in on-site nursing fields a plus · Experience evaluating, quantifying, and developing case management programs desired · Background in business management ¨ Skills · Knowledge regarding relationship of Managed Care Services to Property & Casualty Insurance claim services · Leadership/Management skills · Performance management skills · Excellent analytical skills · Decision making skills · Accuracy and attention to detail · Problem solving · Strong interpersonal and communication skills · Ability to work independently and within a team environment · Ability to function effectively within an ever-changing environment to meet deadlines and reprioritize as necessary · Proficiency in MS Office (Excel, Word, Powerpoint, Project) and data warehouse utilization

Tower Group Companies - 15 months ago - save job - block
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