Nurse Case Manager: Return-to-Work & Care Coordination

Blue Cross Blue Shield of Michigan; United States, Northern America, Americas; Hybrid; USD 63,000 - 90,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a Nurse Case Manager (NCM) to review workers’ compensation claims, apply clinical knowledge, assess treatment appropriateness, and coordinate care to promote timely return to work.

The NCM collaborates with claim handlers, physicians, and claimants ensuring evidence-based decisions, documenting outcomes, and maintaining compliance with applicable regulations.

Qualifications

• Active RN license without restrictions.
• Three years of active clinical care experience as an RN.
• Three years of workers’ compensation case management or related experience preferred.
• BSN preferred or progress toward certification encouraged.

Responsibilities

• Review and manage treatment of workers’ compensation claims based on diagnosis and regulations.
• Obtain and review patient status/history to determine causal relation to work injuries.
• Apply age-specific, cultural, psychosocial, and developmental considerations during interviews and interventions.
• Determine medical necessity and appropriate level of care (inpatient/outpatient).
• Prepare and communicate internal/external correspondence; coordinate with providers and claims handlers.
• Present and finalize alternative care and return-to-work plans with accurate permanency ratings and documentation.

Skills

Clinical care knowledge

Organized / time management

Communication

Report writing

Critical thinking

Computer literacy

Team collaboration

Education

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Windows Suite

Job description

Blue Cross Blue Shield of Michigan is seeking a Nurse Case Manager (NCM) to review workers’ compensation claims, apply clinical knowledge, assess treatment appropriateness, and coordinate care to promote timely return to work.

The NCM collaborates with claim handlers, physicians, and claimants ensuring evidence-based decisions, documenting outcomes, and maintaining compliance with applicable regulations.