Onsite Nurse Case Manager (Hybrid/Remote)

Mem Ins; Ashland (NE); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to ensure patients have access to quality healthcare and facilitate their return to work after injuries. This role involves coordinating treatment plans, advocating for patients, and maintaining communication with medical providers and policyholders. The ideal candidate will have a strong nursing background, preferably with case management experience, and a commitment to improving patient outcomes. Join a values-driven organization that prioritizes safety and success, and make a meaningful impact in the lives of others while growing your career in a supportive environment.

Qualifications

• Minimum three years in Medical/Surgical nursing required.
• Certification in Case Management preferred.
• Current unencumbered RN license from Nebraska or compact state.

Responsibilities

• Coordinate medical treatment plans for work injuries.
• Evaluate injured worker’s potential for return to work.
• Maintain communication with all claim parties involved.

Skills

Case Management

Medical Documentation

Communication Skills

Patient Advocacy

Knowledge of Health Plans

Education

Associate Degree in Nursing

Bachelor’s in Nursing

Tools

Claims Center System

Job description

Job Description

Posted Tuesday, April 15, 2025 at 6:00 AM | Expired Thursday, May 1, 2025 at 5:59 AM

Are you driven to keep people safe? That’s what we do every day at MEM Insurance.

We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us.

SUMMARY:

The role of the Case Manager is to ensure that patients have access to quality, cost-effective healthcare, and to assist in the assessment, development, and coordination of a proactive plan to ensure the best outcome for work injuries. The case manager addresses early return to work and coordinates this process with the policyholder, treating physicians, and the claims team. The nurse case manager will facilitate a safe, effective, early return to work primarily through ongoing personal contact with all parties. Discretion may be used to determine whether this work is performed on-site or remotely.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Case Management

• Accepts case management assignments based on own education, experience, and areas of expertise.
• Collects and assesses data from referral sources and medical treatment providers.
• Initiates in-person or telephonic contact with injured employees, policyholders, therapists, and medical providers as per standards.
• Coordinates and manages medical treatment plans for work injuries.
• Identifies medically necessary services and treatment options to promote quality care. Recommends transfer of care when appropriate per state guidelines.
• Develops individualized medical treatment plans based on patient needs.
• Identifies gaps or inadequacies in treatment to prevent fragmented care.
• Directs care to in-network providers, vendors, and facilities.

Medical Documentation & Communication

• Maintains communication with all claim parties involved.
• Records case management activities accurately.
• Documents activity within the Claims Center system.
• Communicates treatment plan activities and return-to-work issues with all parties.
• Includes estimated cost analysis when closing claims and documents cost savings.
• Maintains confidentiality of information and obtains necessary consents/authorizations.

Return-to-Work Coordination

• Evaluates injured worker’s potential for return to work, considering socio-economic factors, education, and vocational history.
• Establishes a return-to-work target date collaboratively.
• Seeks light duty options for early, safe, gainful employment.
• Recommends vocational rehabilitation if returning to former job isn't possible.
• Sets achievable goals and updates all participants as needed.
• Acts as an advocate for the patient's needs within the workers’ compensation system.
• Builds relationships with injured workers, families, and medical providers to optimize outcomes.
• Supports maximum medical improvement while controlling costs and maintaining quality of care.
• Collaborates with the Nurse Case Management team in line with MEM’s mission, vision, and values.

Professional Development & Representation

• Serves as a resource to claims and MEM staff.
• Explains and demonstrates nurse case management programs to customers.
• Mentors less experienced nurse case managers.
• Represents MEM at professional healthcare activities and internally.
• Participates in conferences, seminars, and meetings as requested.
• Utilizes resources such as the Medical Director and Utilization Management.
• Maintains current resources related to nurse case management.

Administrative & Operational Tasks

• Manages calendar, daily activities, and travel for appointments and treatments.
• Reviews and manages medical records and information.
• Handles communication regarding medical treatment and return-to-work matters.
• Responds to calls, faxes, and emails.
• Enters data into the claims system.
• Researches medical information as needed.
• Participates in special projects and staff meetings.
• Completes continuing education for licensure and certification.
• Maintains communication with supervisors and updates on cases.
• Consults with supervisors on case direction or sensitive issues.

Qualifications:

Education: Associate degree in nursing or diploma RN program, or bachelor’s in nursing.

Designations/Certifications: Certification in Case Management from the Case Management Society of America preferred.

Licenses: Current unencumbered RN license from Nebraska or a compact state (Missouri/Iowa). Valid driver’s license.

Experience: Minimum three years in Medical/Surgical nursing; five years insurance case management preferred.

Skills:

• Knowledge of health plans including medical, dental, and vision.
• Understanding of employer-paid life and disability benefits.
• Familiarity with employee wellness programs, FSA, HSA, and other benefits.