Nurse Case Manager

Nurse Case Manager

Remote, USA

Full time

job requisition id REQ003554

At The Standard, you’ll join a team focused on putting our customers first.

Our continued success is driven by a high-performance culture. We’re looking for people who are collaborative, accountable, creative, agile and are driven by a passion for doing what’s right across the company and in our local communities.

We offer a caring culture where you can make a real difference, every day.

Ready to reach your highest potential? Let’s work together.

JOB PURPOSE

Assess claimants’ medical conditions, diagnostics, procedures performed and ongoing treatment to determine functional capacity levels as well as the appropriateness of care. Collaborate with treating physicians to promote suitable care plans directed toward return to work by communicating with claimants, treating and consulting physicians, employers and benefits personnel. Assess medical record documentation for completeness. Coordinate claim prevention, intervention and return to work programs for employers.

PRINCIPAL ACCOUNTABILITIES / ESSENTIAL FUNCTIONS

Contribute to the company’s success through excellent customer service and meeting or exceeding performance objectives for the following major job functions:

• Evaluate medical history and treatment and test results during file reviews and consultations with division benefits staff. Provide assessments of claimants’ functional capacity and their levels and expected durations of impairment. Identify and resolve stated limitations inconsistent with medical documentation. Assess medical records to determine if claim for disability is caused or contributed to by a limited or excluded medical condition.
• Assess adequacy and appropriateness of treatment. Advocate on behalf of the claimant for appropriate services and treatment to attain maximum medical improvement and successful return to work. Work in conjunction with vocational and benefits staff to assess claimants’ psychosocial, environmental and financial status. Communicate with claimants, their families, employers, medical treatment providers, rehabilitation counselors and other carriers such as workers’ compensation providers or HMO’s, to ensure understanding of and cooperation with the recommended treatment plans and the goal of returning to work.
• Provide claim prevention services by working with employers to evaluate their organizations’ trends in disabilities. Coordinate site visits and assessments; advise on educational programs for employee groups; work in conjunction with vocational staff to recommend job site modifications and safety or procedural changes. Collaborate with sales, underwriting, and vocational and benefits staff to recommend, develop and implement intervention and return to work programs and practices for employers.
• Develop and conduct medical education and training for division claims personnel.

ESSENTIAL FUNCTION REQUIREMENTS

• Demonstrated skills: Effective case management. Effective identification and resolution of problems. Clear and persuasive expression of ideas in both written and oral communications. Effective collaboration with peers and team members.
• Ability to: Utilize computer software and hardware applications. Talk by telephone. Shift priorities to meet demands from various customer groups. Make decisions in the absence of specific direction. Facilitate group discussions. Achieve professional designation.
• Working knowledge of: Assistive devices needed by people with disabilities. The Americans with Disabilities Act, family leave laws, Fair Claims Settlement Practices Act, and laws governing client confidentiality.

QUALIFICATIONS

• Education: BS or MS in a related field.
• Experience: A minimum of 4 years hospital or clinical experience in relevant medical fields (e.g. cardiology, orthopedics, mental health) or utilization review or quality management, or the equivalent combination of education and/or relevant experience.
• Professional certification required: Current Registered Nursing license, with a CCM or CPDM designation or ability to obtain such a designation within 2 years of hire. Is a job requirement

#LI-REMOTE

Please note – the salary range for this role is listed below. In addition to salary, our package includes incentive plan participation and comprehensive benefits including medical, dental, vision and retirement benefits, as well as an initial PTO accrual of 164 hours per year. Employees also receive 11 paid holidays and 2 wellness days per year.

• Eligibility to participate in an incentive program is subject to the rules governing the program and plan. Any award depends on various factors, including individual and organizational performance.

Salary Range:

$71,000.00 – $104,000.00