Medical Case Manager Job
Travelers - Charlotte, NC

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Solid reputation, passionate people and endless opportunities.

That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.

Hello and thank you for viewing this pipeline job posting. Please note that there is currently no opening for this position. This particular posting has been created in an effort to help pre-identify candidates interested in being considered for future roles as they become available. By submitting your resume to this requisition, you are not formally applying for a position with Travelers, rather you are indicating an interest in being contacted when roles like this open.

Work Regular Hours in a Business Setting
Monday through Friday
No Nights! No Weekends! Holidays Off!
No On Call!! - No Field Travel!!

Working as a Medical Case Manager, a valuable member of our Workers Compensation Claims Management Team, your medical training and experience as a licensed RN along with our comprehensive training will help ensure our injured workers receive appropriate medical care enabling them to recover and make a timely and safe return to active employment.

Your role will involve computer system documentation, telephone contact with injured workers, and communication with physicians, other medical providers and employers. You will work side-by-side with claims adjusters providing them with professional and technical expertise on all aspects of medical management.

To be qualified for this role, you must have a current relevant State Nursing License and at least two years of clinical experience. You must have excellent written and oral communication skills and you must be proficient in all PC applications. We offer a competitive compensation package; medical, dental, eye, 401k and 20 days of paid time off plus holidays.

SUMMARY:
Office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.

PRIMARY DUTIES AND RESPONSIBILITIES:
Contact medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care. Develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management. Responsible for ongoing evaluation of treatment and return to work plan, within established protocols.
Work with medical providers and suggest cost effective treatment alternatives, when appropriate. Help ensure that all injured parties are on an aggressive treatment plan. Authorize medical treatment and associated diagnostictesting on assigned claims as allowed by state or policy jurisdictions. For nurses handling Workers Compensation Claims, perform Utilization Review according to established guidelines. Utilize physician advisor program.
Proactively manage the medical expenses by partnering with specialty resources to achieve appropriate claim outcomes (SIU, Legal, Risk Control, Disability Management, IME and Peer Review vendors, Major Case, etc.)
Obtain medical records from providers telephonically during initial contact, and follow up with written correspondence if necessary. Discuss medical information and disability status with claim handler and integrate into overall strategy to ensure appropriateness of indemnity payments. Provide technical assistance and act as a resource for claim handling staff.
Contact employer to initiate modified duty or full return to work. Obtain job description and discuss job modifications required to ensure a prompt return to work. Medical Case Manager will work with employer, injured party, provider and claim handler to expedite return to work.
Identify cases requiring task assignments to field case managers, discuss with supervisor for assignment to Medical or Vocational Case Manager, or vendor.
Document all contacts and outcomes related to case activity in system. Submit billing reports on all activities per established guidelines.
Provide feedback to Preferred Provider Network regarding provider nominations and experience with providers.
Comply with established Best Practices
Perform other duties as required.

EDUCATION/COURSE OF STUDY:
Registered Nurse or other qualified health professionals.

CDMS, CRC, CCM, CRRN desirable

WORK EXPERIENCE:
Disability case management experience preferred.

CERTIFICATES/DEGREES:
Appropriate license per state regulation

COMMUNICATION SKILLS:
Very strong oral and written communication skills.

COMPUTER SKILLS:
Good computer skills

OTHER:
Strong clinical background.
Knowledge of medical causation and relatedness, as well as use of medical treatment protocols and physician advisor/peer review programs.
Understanding of Workers Compensation laws or Auto First Party Medical preferred.

File Management
Nursing skills and knowledge
Customer Focus/ Communication
Relationship Management
Use of Technology

Travelers is an equal opportunity employer. We actively promote a drug-free workplace.

Job Category : Nurse - Medical Case Manager

Travelers - 19 months ago - save job - block
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Carlson Wagonlit Travel (CWT) is a global leader specializing in business travel management. CWT is dedicated to helping companies of all...