Managing Cases Assessing, planning, coordinating, monitoring, and evaluating the services each injured worker needs, with high-quality work on every file. This is a leadership-minded position for a nurse who combines strong clinical judgment with sharp communication skills and a passion for helping people get back on their feet.

Senior Patient Advocate
Pay: $80,000 – $90,000 per year
Location: Hybrid, near Albany, NY
Employment Type: Full-Time

The Opportunity

Our client is looking for an experienced registered nurse to take a senior case management role on its claims team. You'll guide injured workers through treatment and recovery, help them return to work safely and promptly, and serve as a go-to clinical resource for colleagues. This is a leadership-minded position for a nurse who combines strong clinical judgment with sharp communication skills and a passion for helping people get back on their feet.

What You'll Be Doing

Managing Cases

• Assessing, planning, coordinating, monitoring, and evaluating the services each injured worker needs, with high-quality work on every file
• Prioritizing your caseload so every claim is handled properly and reaches prompt resolution
• Working with injured workers, providers, employers, and others to define return-to-work capabilities and promote transitional duty programs
• Tracking expected disability duration against published criteria throughout the life of each claim
• Reviewing medical records, interpreting them for colleagues, and acting when treatment goes beyond state treatment guidelines
• Looking for ways to reduce medical costs and improve outcomes, documenting your impact, and negotiating services and equipment when needed
• Completing medical cost reviews to help set accurate reserves, and helping prepare files for settlement or litigation

Advising and Leading

• Giving medical management recommendations to case analysts and management and shaping the medical side of each claim with them
• Serving as a resource to claims staff and other advocates, and providing or coordinating training
• Taking a leadership role in process improvements and helping develop case management policies and procedures
• Joining claim reviews, member orientations, and presentations, and representing the organization professionally
• Supporting workplace wellness efforts and contributing to special projects

Staying Current and Compliant

• Following legal and regulatory standards and keeping up with medical and legal developments in workers' compensation
• Maintaining claim files in the claims system and completing forms accurately and on time
• Responding to member interactions and alerts according to service standards

What You Bring

• Active registered nurse license in the applicable state, with a strong clinical background
• National case management certification (such as CCM, COHN, CIRS, or CRC) is required; a CCM can be earned within two years of hire
• 5+ years of case management experience preferred, ideally in an insurance setting
• Critical care and occupational health experience are preferred
• Excellent written and verbal communication with providers, injured workers, employers, and other parties
• Leadership ability, professional judgment, and the ability to work with minimal direction
• Strong customer service, solid Microsoft Windows skills, and good keyboarding
• Ability to be bonded

Work Setting

• Hybrid schedule alternating between the office and home, with mostly desk and phone work (about 40% computer and 40% phone)
• Occasional visits to members and meetings (about 20% of the time); reliable personal transportation required
• Occasional lifting, bending, reaching, and carrying

 
To see a full listing of all our open positions, please visit:
https://www.redshiftrecruiting.com/jobs-hiring-near-me
 
redShift Recruiting is the region's premier recruiting agency with over 100 years of combined experience in the recruiting field. We specialize in permanent, temporary, and temp-to-hire positions. Our superior service combined with our highly qualified and carefully selected bank of candidates sets us apart.