Nurse Medical Case Manager-Workers Compensation - Rancho Cordova/Sacramento, California
Solid reputation, passionate people and endless opportunities.
That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.
We currently have a position as a Workers Compensation Medical Case Manager. Bi-lingual Spanish speaking encouraged to apply.
Location: Rancho Cordova/Sacramento, California
Tired of Hospital Nursing?
Are you interested in a new experience? Learn to be a Medical Case Manager in a highly energized and collaborative working environment!
We have an exciting and unique opportunity for an entry level Medical Case Manager, a valuable member of our Workers Compensation Claims Management Team. You will learn about claims and use your medical training and experience as a licensed RN or LVN to help ensure our injured workers receive appropriate medical care enabling them to recover and make a timely and safe return to active employment.
*Travelers has an ongoing training program that will assist you in making your transition to Medical Case Manager.
As a member of the Workers Compensation Medical Management team you will develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management. Through contacts with medical providers and injured parties you will coordinate appropriate medical care, assess and evaluate treatment for return to work, and proactively manage medical expenses by partnering with specialty resources to achieve the appropriate health outcomes. Provide technical assistance and act as a resource for claim handling staff.
Candidates with 2+ years nursing experience; a degree from an accredited nursing school is required. LVN or Registered Nurse; CDMS, CRC, CCM, CRRN certifications are helpful but not necessary. An appropriate unrestricted license per state regulation is required.
Candidates must have strong oral and written communication skills, good computer skills, negotiation and time management skills, high degree of flexibility, willingness to learn the claims business.
The preferred candidate will have clinical nursing experience, knowledge of medical causation and relatedness, experience with medical treatment protocols and physician advisor/peer review programs. An understanding of Workers Compensation laws or Auto First Party Medical is preferred.
Opportunities in our Rancho Cordova/Sacramento and Walnut Creek offices.
Candidates with bi-lingual capability are encouraged to apply.
PRIMARY DUTIES AND RESPONSIBILITIES:
Contact medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care. Develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management. Responsible for ongoing evaluation of treatment and return to work plan, within established protocols.
Work with medical providers and suggest cost effective treatment alternatives, when appropriate. Help ensure that all injured parties are on an aggressive treatment plan. Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions. For nurses handling Workers Compensation Claims, perform Utilization Review according to established guidelines. Utilize physician advisor program.
Proactively manage the medical expenses by partnering with specialty resources to achieve appropriate claim outcomes (SIU, Legal, Risk Control, Disability Management, IME and Peer Review vendors, Major Case, etc.)
Obtain medical records from providers telephonically during initial contact, and follow up with written correspondence if necessary. Discuss medical information and disability status with claim handler and integrate into overall strategy to ensure appropriateness of indemnity payments. Provide technical assistance and act as a resource for claim handling staff.
Contact employer to initiate modified duty or full return to work. Obtain job description and discuss job modifications required to ensure a prompt return to work. Medical Case Manager will work with employer, injured party, provider and claim handler to expedite return to work.
Identify cases requiring task assignments to field case managers, discuss with supervisor for assignment to Medical or Vocational Case Manager, or vendor.
Document all contacts and outcomes related to case activity in system. Submit billing reports on all activities per established guidelines.
Provide feedback to Preferred Provider Network regarding provider nominations and experience with providers.
Comply with established Best Practices
Perform other duties as required.
EDUCATION/COURSE OF STUDY:
Registered Nurse or other qualified health professionals.
CDMS, CRC, CCM, CRRN desirable
Disability case management experience preferred.
Appropriate license per state regulation
Very strong oral and written communication skills.
Good computer skills
Strong clinical background.
Knowledge of medical causation and relatedness, as well as use of medical treatment protocols and physician advisor/peer review programs.
Understanding of Workers Compensation laws or Auto First Party Medical preferred.
Nursing skills and knowledge
Customer Focus/ Communication
Use of Technology
Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
Please see description.
The Travelers Companies, Inc. (NYSE: TRV) is a leading property casualty insurer selling primarily through independent agents and brokers. The company's diverse business lines offer its global customers a wide range of coverage in the auto, home and business settings. A component of the Dow Jones Industrial Average, Travelers has more than 30,000 employees and generated revenues of approximately $25 billion in 2010.
To learn more about careers at Travelers visit us at travelers.com/Careers.
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