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Case Manager II, RN

Case Manager II, RN

Job Description

Provides case management or consulting services on multiple lines of business, including, but not limited to catastrophic and non-catastrophic workers’ compensation claims, liability or auto/med PIP. Services may be delivered either telephonically or in person in the field. Services are provided in a timely manner and in accordance with legal statutes, policy provisions and company guidelines.

Essential Functions:

  • Provides medical case management services to catastrophic or other complex cases on workers’ compensation, auto/med PIP or first pay bodily injury (BI) liability claims. Examples of complex cases may include, but are not limited to the following: Head injuries; Multiple traumas; Burns; Spinal cord injuries; Amputations; Chronic pain management; Medical conditions with complex ancillary or specialty services requiring extensive research of options and providers; Complex psychosocial factors requiring extensive assessment and intervention; Cases requiring a high level of negotiation and coordination with all parties to enable “stay at work” or “return to work” opportunities. Provides nurse consulting services on workers’ compensation and liability claims.
  • Analyzes workers’ compensation files and recommends actions to facilitate resolution.
  • Analyzes special damages on BI files and provides defense strategy recommendations to mitigate exposures.
  • Serves as either a consultant or case manager, but never both on the same file.
  • Periodically serves as a resource regarding local jurisdictional regulatory issues.
  • Periodically assists with special projects assigned by the Managed Care Department.
  • May be assigned as a mentor to a Level 1 Case Manager.
  • Applies the case management process of assessment, planning, implementation, coordination, monitoring and evaluation. Serves as an advocate for the injured worker, within the parameters of the applicable jurisdiction.
  • Develops and implements action plans on complex case management cases.
  • Establishes short and long term goals with assigned target dates to achieve optimal medical outcomes and minimal lost time from work.
  • Delivers quality services by adherence to corporate policies and procedures, best practices, client special handling instructions and applicable regulatory requirements.
  • Complies with corporate time and billing policies.
  • Maintains professional standards and ethical codes of conduct as required by the nursing license(s) and professional certification(s) held by the case manager.
  • Uses highly developed telephonic skills to successfully conduct services.
  • Follows referral criteria for involvement of field case management services.
  • Adheres to assignment criteria for either task or full case management.
  • Plans travel and work activities for efficiency, in accordance to corporate policies and best practices.
  • Develops relationships and knowledge of community resources to facilitate cooperation and involvement of parties. li>Maintains safety awareness and practices when working in the field environment.

Job Requirements

  • Active registered nurse license(s) for assigned jurisdiction(s); Multi-state assignments as required.
  • Bachelors degree in Nursing, Healthcare and or Occupational Medicine.
  • Three to five years experience in any of the following specialties: Clinical facility in the areas of orthopedics, neurology, critical care, emergency trauma, general surgery or rehabilitation/physical medicine; Occupational health; Workers’ compensation case management; General liability or Auto/med PIP.
  • Current professional certification(s): Certified Case Manager (CCM); Certified Disability Management Specialists (CDMS); Certified Rehabilitation Registered Nurse (CRRN); Certified Occupational Health Nurse (COHN); Legal Nurse Consultant, Certified (LNCC); Certified Legal Nurse Consultant (CLNC).
  • State specific registrations or certifications, as required by various workers’ compensation jurisdictions.

Job Snapshot

Employment Type Full-Time
Job Type Nurse, Management, Health Care
Education 4 Year Degree
Experience Up to 5 year(s)
Manages Others Not Specified
Industry Insurance, Consulting
Required Travel Not Specified
Job ID 285
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Case Manager II, RN

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