Senior Nurse Case Manager - Remote/Field Claims Leader

Blue Cross Blue Shield of Michigan; Brighton (MI); Hybrid; USD 74,000 - 123,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a Senior Nurse Case Manager to support the Claims Department in reviewing complex workers’ compensation claims and guiding return-to-work decisions. The role may function telephonically or as a Field NCM, involving on-site care and coordination with providers, employers, and injured workers.

You will oversee assignments, assess medical necessity, and help develop cost containment strategies while mentoring junior staff and contributing to monthly

Qualifications

• RN license active and unrestricted
• BSN preferred
• Strong negotiation and decision-making skills
• Excellent oral and written communication
• Proficient with Microsoft Windows Suite

Responsibilities

• Oversee new assignments and make timely initial contacts with all parties.
• Review patient clinical status to determine causality of symptoms relative to work injuries.
• Coordinate with employer for early return to work or alternative duty.
• Manage external nurse case management tasks and document cost benefits.
• Communicate final decisions and implications to claims representatives.
• Medically manage claims in multiple jurisdictions.
• Train and mentor nurse case managers.
• Prepare presentations for prospective customers.

Skills

Negotiation skills

Communication skills

Leadership abilities

Analytical skills

Team collaboration

Independent work

Project management

Education

RN license active/unrestricted

BSN preferred

Tools

Microsoft Windows Suite

Job description

Blue Cross Blue Shield of Michigan is seeking a Senior Nurse Case Manager to support the Claims Department in reviewing complex workers’ compensation claims and guiding return-to-work decisions. The role may function telephonically or as a Field NCM, involving on-site care and coordination with providers, employers, and injured workers.

You will oversee assignments, assess medical necessity, and help develop cost containment strategies while mentoring junior staff and contributing to monthly