Senior Nurse Case Manager: Field & Return-to-Work Leader

Emergent Holdings, Inc.; Chicago (IL); Hybrid; USD 74,000 - 123,000; Full time

Job summary

Emergent Holdings, Inc. is seeking a Senior Nurse Case Manager to support the Claims Department, review complex workers’ compensation claims, determine medical necessity, and facilitate return-to-work for injured employees.

The role may be conducted telephonically or as Field NCM with on-site coordination. You will lead and mentor nurse case managers, develop cost containment initiatives, and collaborate with providers, employers, and claims representatives to implement strategic initiatives and

Qualifications

• Active and unrestricted Registered Nurse license.
• BSN preferred.
• Five years of progressive responsibility in injury case management.
• Three years of active clinical RN experience.
• Three years of workers’ compensation case management or related experience preferred.
• Field NCMs require an unrestricted and valid driver’s license.

Responsibilities

• Oversee new assignments and make timely initial contacts with all parties.
• Review patient clinical status and history to determine causation of symptoms.
• Complete RN template and documentation including medical history and cost drivers.
• Negotiate and coordinate with employer for early RTW or alternative duties.
• Provide oversight of external nurse case management and RN tasks; document POA and cost benefits.
• Apply medical knowledge during physician contacts for prolonged treatment cases.
• Determine medical necessity of proposed/ongoing treatment and hospitalization decisions.
• Conduct case research and coordinate with employees, employers, physicians and staff.
• Refer cases not meeting criteria to medical director or consultants.
• Prepare internal/external correspondence and communicate final decisions to claims.

Skills

RN experience

Negotiation

Communication

Leadership

MS Windows

Education

RN license

BSN preferred

Tools

Microsoft Windows Suite

Job description

Emergent Holdings, Inc. is seeking a Senior Nurse Case Manager to support the Claims Department, review complex workers’ compensation claims, determine medical necessity, and facilitate return-to-work for injured employees.

The role may be conducted telephonically or as Field NCM with on-site coordination. You will lead and mentor nurse case managers, develop cost containment initiatives, and collaborate with providers, employers, and claims representatives to implement strategic initiatives and