Nurse Case Manager

Emergent Holdings, Inc.; United States; On-site; USD 63,000 - 90,000; Full time

Job summary

Emergent Holdings, Inc. seeks a Nurse Case Manager to review workers’ compensation claims, apply medical guidelines, and oversee treatment appropriateness. You will coordinate care, engage claimants and physicians, and support timely return-to-work outcomes.

The ideal candidate holds an active RN license, a BSN is preferred, and certification progress is encouraged. Three years of RN experience and relevant workers’ compensation exposure are required. California considerations apply.

Qualifications

• Active RN license required.
• BSN preferred; certification encouraged.
• Three years of active patient care as an RN; three years in workers’ compensation case management or related field preferred.

Responsibilities

• Review patient status and history to determine relation to work injuries.
• Consider age, culture, psycho-social factors during interviews and documentation.
• Assess medical necessity and hospitalization needs for lost-time cases.
• Prepare correspondence to research and resolve disputes with providers and claims handlers.
• Present and finalize alternative care and return-to-work plans with accurate ratings.
• Adhere to California Nurse Practice Act and related codes for CA cases.

Skills

Clinical nursing

Case management

Communication skills

Time management

Microsoft Office

Education

RN license active

BSN preferred

Job description

Job Description

The Nurse Case Manager (NCM) is responsible for applying medical knowledge in reviewing workers’ compensation claims to assess, evaluate, plan, implement and oversee the treatment appropriateness for occupational injuries based upon evidence based guidelines. The NCM utilizes clinical knowledge to evaluate the medical and disability needs of an injured worker against relevant policies, facilitate coordination of the patient’s medical treatment and timely return to work. The NCM engages the claimant and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers in providing focused claim resolution and return to work driven outcomes. The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes.

Responsibilities / Tasks

• Obtains and reviews patient clinical status and history to determine casual nature of patient’s symptoms as related to reported work injuries.
• Applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during the interview process, documentation and intervention with the claimant, their family or significant other.
• Determines the medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case.
• Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required. Communicates final decision and subsequent ramifications to claim handlers.
• Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers’ compensation, state, industry and division rating standards and policies, in conjunction with the claim handler.
• As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct

Employment Qualifications

Registered Nurse license active and unrestricted required. Bachelor’s degree in Nursing (BSN) preferred. Continuous learning required, as defined by the Company’s learning philosophy. Certification or progress toward certification is highly preferred and encouraged.

Experience

Three years active patient or clinical care experience as a Registered Nurse required. Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred.

Skills / Knowledge / Abilities (ska) Required

• Knowledge of clinical care and jurisdictional requirements.
• Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
• Strong time management skills.
• Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required.
• Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making.
• Proficient with computer and Microsoft Windows Suite.
• Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.

Working Conditions

Work is performed in an office setting with no unusual hazards. Minimal travel.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.

Pay Range

Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $63,000 and $90,400.