Clinic Nurse Medical Case Manager - Centennial, CO

VetJobs - Centennial, CO

Job Title: Clinic Nurse Medical Case Manager - Centennial, CO

Position: Medical Case Manager

Job Type: Full Time

Pay: $83,300.00 - $137,400.00

Shift:

Work Type: On-Site

Location

Address:

City: Centennial

State: CO

ZIP Code:

Job Responsibilities

Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan.
Contact customer, medical provider, and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement.
Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
Utilize Preferred Provider Network Per Jurisdictional Guidelines.
Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
Submit accurate billing documentation on all activities as outlined in established guidelines.
Participate in Telephonic and/or onsite File Reviews.
Respond to inquiries - oral and written.
Keep injured worker apprised of claim status.

Required Skills

Core Skills

Analytical Thinking
Communication
Negotiation
General Insurance Contract Knowledge
Principles of Investigation
Value Determination
Legal Knowledge
Medical knowledge
WC Technical
Customer Service
Teamwork
Planning & Organizing

Preferred Skills

RN preferred
Disability Case Management Experience
Prior clinical experience
Familiarity with URAC standards
Certified Case Manager (CCM)
Certified Disability Management Specialist (CDMS)
Clinical Research Counselor (CRC)
Certified Rehab Registered Nurse (CRRN)

Requirements

Experience:

Education: Associates

License & Certification:

Registered Nurse
Licensed Practical Nurse
Licensed Vocational Nurse

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Performance-based cash incentive awards

Supplemental Pay

Not specified

Special Notes

Open to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.
Acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements.