Onsite Nurse Case Manager (Hybrid/Remote)

MEM; Waverly (NE); Remote; USD 65,000 - 85,000; Full time

Job summary

A leading insurance company seeks a dedicated Case Manager to enhance patient support by managing healthcare access and coordinating return-to-work efforts. The ideal candidate will possess nursing qualifications along with significant experience in case management. Join MEM and contribute to making a positive impact on the lives we touch.

Benefits

Generous paid time off and holidays

Employee Assistance Programs

401k with employer match

Qualifications

• Current RN license from Nebraska or a compact state.
• At least 3 years in Medical/Surgical nursing.
• 5 years insurance case management preferred.

Responsibilities

• Coordinate medical treatment plans for work injuries.
• Facilitate early return to work through contacts with all parties.
• Evaluate injured workers' potential for return to work.

Skills

Knowledge of Medical, Dental, and Vision plans

Employer-paid Life and Disability benefits

Employee wellness programs

Education

Associate degree in nursing, diploma RN, or bachelor’s degree in nursing

Certification in Case Management

Job description

Papillion, NE, USA •

Fremont, NE 68025, USA •

Waverly, NE 68462, USA •

Job Description

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 the return to work with the policyholder, treating physicians, and claims representatives. The nurse case manager will facilitate a safe, effective, early return to work 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 education, experience, and 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; 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 parties involved in the claim.
• Records case management activities and documents activity within the Claims Center system.
• Communicates treatment plan activities and return-to-work issues.
• Includes estimated cost analysis when closing claims and documents cost savings.
• Maintains confidentiality 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 return-to-work target dates collaboratively.
• Seeks light duty options for early, safe return to employment.
• Recommends vocational rehabilitation if return to former job isn’t possible.
• Sets achievable goals and updates all parties on treatment plan changes.
• 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 aligned with MEM’s mission and values.

Professional Development & Representation

• Serves as a resource to claims representatives and staff.
• Explains and demonstrates nurse case management programs to customers.
• Mentors less experienced nurse case managers.
• Represents MEM in professional healthcare activities and internal meetings.
• Attends conferences, seminars, and participates in calls or meetings as requested.
• Utilizes resources such as the Medical Director, Utilization Management, and ODG.
• Maintains a current resource file on articles, community resources, and in-service information.

Administrative & Operational Tasks

• Manages calendar, daily activities, and travel planning.
• 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.
• Obtains continuing education for licensure and certification.
• Maintains communication with supervisors and updates on cases.
• Consults with supervisors on case directions or sensitive issues.

QUALIFICATIONS:

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

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

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

Experience: At least 3 years in Medical/Surgical nursing; 5 years insurance case management preferred.

Skills:

• Knowledge of Medical, Dental, and Vision plans, including fertility benefits, orthodontia, and preventative care.
• Employer-paid Life and Disability benefits, including life insurance (3x salary), AD&D, and STD/LTD.
• Employee wellness, recognition programs, and flexible spending accounts.
• Health Savings Account with employer contributions.
• Generous paid time off, holidays, volunteer time, parental leave, and other leaves.
• Employee Assistance Programs.
• 401k with employer match and profit sharing.