Telephonic Nurse Case Manager

Telephonic Nurse Case Manager

United States – Remote

Full time

82375

If you’re passionate about helping people protect what matters most to them, as well as innovating and simplifying processes and operations to provide the best customer value, then Nationwide’s Property and Casualty team could be the place for you!

Territory: The location of this position is flexible and open to virtual and/or remote based applicants.

What you can expect: The Telephonic Nurse Case Manager is a member of the Worker’s Compensation team here at Nationwide. Your role is triaging your case load and determining our members needs in a timely manner to provide exceptional service and results. This is a three point contact position in which you will communicate with the members, injured Associate, claims specialist/adjuster, and the doctor or care provider. Your goal is ensuring the Associate returns to work safely and effectively.

You are expected to practice lean management principles on a daily basis.

The ideal candidate will have:

• Be a Registered Nurse (RN) with valid licensing.
• Bachelor’s of Nursing (BSN) is preferred.
• Certified Case Manager (CCM) preferred.
• Compact licensure required. Illinois and California licensure preferred,
• (For internal use only) Compensation Grade: F3

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range. The role may also be eligible for either short-term or long-term incentive plans based on business and/or position-specific results. Newly hired full-time associates receive a minimum of 18 days paid time off each full calendar year, pro-rated quarterly based on hire date. Newly hired full-time associates at higher job levels may receive additional paid time off. You will also receive 8 hours of Lifetime paid time off and 8 hours of Unity Day paid time off. The range for this role is listed below.

In Washington, the salary range for a Telephonic Nurse Case Manager is $66,500.00 to $131,500.00.

Job Description Summary

As a Telephonic Nurse Case Manager, you will be responsible for office based medical and disability case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment. You will also be responsible for helping to ensure injured workers receive appropriate treatment directly related to the compensable injury and for assisting claim handlers in managing medical treatment to an appropriate resolution and being an advocate to the injured employee/family, employer, provider(s), insurance company, and healthcare personnel.

Job Description

Key Responsibilities:

• Works telephonically with workers’ compensation patients, employers, providers, and claim handlers to coordinate and assure proper delivery and oversight of medical and disability services.
• Authorizes medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.
• Evaluates and coordinates quality, cost effective medical and rehabilitative services. Proactively manages the medical expenses by partnering with specialty resources (i.e. diagnostic and other ancillary services vendors) to achieve appropriate claim outcomes.
• Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes.
• Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care.
• Assists the injured worker by providing medical and disability education and coordinating on-site job analysis; work conditioning; functional capacities; and ergonomic evaluations.
• Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work.
• Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches; over or underutilization; inappropriate care; effective treatment; permanent or temporary loss of function; failed or premature return to work; and non-compliance.
• Adheres to all appropriate privacy, security and confidentiality policies and procedures. Complies with established Best Practices.

May perform other responsibilities as assigned.

Reporting Relationships: Reports to Manager or Director. No direct reports but may lead others on projects and assignments.

Typical Skills and Experiences:

Education:

• Bachelor’s Degree required.

License/Certification/Designation:

• Registered Nurse (RN) with current state license(s) required. CDMS, CRC, CCM, or CRRN designation desirable.

Experience:

• Three or more years of clinical experience required, preferably in emergency room, orthopedics, neurological, critical care, and/or physical rehabilitation setting. Previous Workers’ compensation or disability case management experience preferred.

Knowledge, Abilities and Skills:

Knowledge of medical causation and relatedness as well as medical diagnostics, procedures and treatment standards is necessary. Understanding of Workers’ Compensation laws preferred. Excellent written and verbal communication, organizational and interpersonal, customer service, time management, and problem-solving skills required. Proficiency in Microsoft Office products, such as Word, Excel and Teams, as well as experience with internet searches and a comfort level with other software programs required. Ability to set priorities and work independently is essential.

Other criteria, including leadership skills, competencies and experiences may take precedence.

Staffing exceptions to the above must be approved by the hiring manager’s leader and HR Business Partner.

Values: Regularly and consistently demonstrates the Nationwide Values.

Job Conditions:

Overtime Eligibility: Exempt (Not Eligible)

Working Conditions: Normal office environment. Occasional travel may be required.

ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.

Benefits

• We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.

Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.

#claimsSmoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247.

For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in California is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $115,500.00

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in Colorado is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $102,500.00

Nationwide pays based on a geographic-specific salary structure. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role as well as the cost of labor in the market; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. The range for this role in New York is listed below. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.$66,500.00 – $139,000.00