Nurse Medical Case Manager - Workers Compensation - Brookfield, WI

VetJobs; Brookfield (WI); On-site; USD 75,000 - 100,000; Full time

Job summary

An established industry player is seeking a Nurse Medical Case Manager to join their team in Brookfield, WI. This full-time role focuses on providing telephonic medical case management for workers' compensation claims, ensuring injured parties receive the necessary treatment and support for their recovery. You will collaborate with medical providers and claim handlers to facilitate return-to-work strategies and manage medical treatments effectively. If you have a passion for helping others and possess strong analytical and communication skills, this opportunity is perfect for you.

Qualifications

• Registered Nurse or equivalent license required for the role.
• Experience in Disability Case Management preferred.

Responsibilities

• Coordinate medical care and facilitate return to work for injured employees.
• Evaluate medical treatment requests and maintain communication with injured workers.

Skills

Analytical Skills

Communication Skills

Negotiation Skills

Investigative Skills

Education

Registered Nurse License

Licensed Practical Nurse License

Additional Certifications (CCM, CDMS, CRC, CRRN)

Tools

Claim Platform Systems

Job description

Nurse Medical Case Manager - Workers Compensation - Brookfield, WI

Join us to apply for the Nurse Medical Case Manager - Workers Compensation - Brookfield, WI role at VetJobs.

Job Overview

Under moderate supervision, provide telephonic office-based medical case management focusing on early intervention, return-to-work planning, and coordinating quality medical care for claims involving disability and medical treatment. Assist in ensuring injured parties receive appropriate treatment related to their injury and support claim handlers in managing medical treatments to resolution.

Key Responsibilities

1. Contact customers, medical providers, and injured parties to coordinate medical care and facilitate return to work.
2. Develop and update strategies for injured employees' return to work and medical improvement.
3. Coordinate with medical providers to ensure active participation in treatment plans.
4. Evaluate medical treatment requests for reasonableness and necessity.
5. Engage specialty resources as needed for optimal resolution.
6. Partner with Claim Professionals to provide medical information and disability status.
7. Utilize Claim Platform Systems to manage claim activities timely.
8. Participate in File Reviews and respond to inquiries.
9. Maintain communication with injured workers regarding claim status.

Qualifications

• Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license required.
• Disability Case Management experience and clinical background preferred.
• Familiarity with URAC standards and jurisdictional guidelines.
• Strong analytical, communication, negotiation, and investigative skills.
• Knowledge of insurance contracts, legal procedures, and medical assessments.
• Additional certifications such as CCM, CDMS, CRC, or CRRN are preferred.

Compensation and Location

Salary range: $75,000 - $100,000 annually, based on experience and location.

Additional Details

This position is full-time, entry-level, located in Brookfield, WI, and involves working within a team to manage workers' compensation claims effectively.