Nurse Case Manager Team Lead

This is an exciting, remote opportunity for an experienced R.N. with prior telephonic Workers’ Compensation case management experience to lead a telephonic nurse case management team and provide superior customer service to insureds and injured workers while handling a reduced case management caseload. The Team Lead will supervise a Workers’ Compensation nurse case management team providing nationwide telephonic nurse case management support to a rapidly growing Workers’ Compensation claims department. The nurse case management team oversees the medical aspects of work-related injuries, ensuring injured workers receive appropriate care while managing costs and facilitating a safe return to work. In collaboration with claims representatives, the nurse case management team is responsible for developing medical and disability management strategies for an assigned caseload within jurisdictional requirements. The nurse case management team also completes pharmacy benefit management for the Workers’ Compensation department and triages new Workers’ Compensation claims to ensure the right resources are assigned to a claim from the outset. Caseload severity ranges from medical only to catastrophic/complex claims across multiple jurisdictions.

Location: This is a full-time remote position and can be located anywhere in the United States if the candidate has a Compact+ RN license. The candidate must be willing to obtain non-Compact state licenses as needed (i.e. CA, DC, IL, MI, MN, & NY.) This position may require occasional travel to attend trainings and/or other related department meetings.

Job Responsibilities

The Team Lead- Nurse Case Management will be responsible for, but not limited to:

• Lead, supervise and support a telephonic nurse case management team completing claim triage, pharmacy benefit management, and case management services nationwide to achieve department goals by promoting compliance within regulatory and company guidelines
• Set priorities for the nurse case management team to ensure performance goals are met and drive consistency across the team
• Conduct weekly team meetings and regular check-in discussions with individual team members
• Monitor team performance, provide feedback, and conduct performance evaluations
• Manage a reduced pending of telephonic task and full case management Workers’ Compensation referrals; Provide medical case management through telephonic communication with injured employees, physicians, employers, health care providers, vocational rehabilitation consultants and others
• Evaluate injured employees’ responses to medical treatment and using clinical expertise, recommend alternative treatment or care options as needed
• Estimate medical treatment and recovery time guidelines to assist Claims with evaluating claim reserves
• Implement a nurse case management audit process to drive consistency across the department; responsible for monitoring the quality of work produced and coaching team towards consistent and improved performance
• Participate in the recruitment, selection and hiring of team members
• Provide superior customer service and facilitate clear communication and collaboration among multiple parties, including the injured worker, employer, claims representative, legal, and healthcare providers
• Independently manage workload, including prioritizing cases and determining how to manage cases effectively
• Partner with Claims leadership to determine best practices and promote teamwork
• Serve as a nurse case management subject matter expert; participate in internal and external projects as needed
• Partner with Supervisor to identify training opportunities
• Mentor and train new team members, ensuring they are proficient in case management principles and procedures consistent with company best practices
• In a backup capacity, triage incoming Workers’ Compensation claims and assign claims to claims staff based on injury severity
• Report vendor changes or delays to ensure vendors meet service level agreement expectations
• Collect and evaluate data from multiple sources to monitor and improve nurse case management performance
• Identify, implement and manage process enhancements to improve overall team delivery of case management services to align with organizational goals
• Serve as a clinical resource to claims staff
• Protect the confidentiality of protected health information and other confidential information
• Work with employers and physicians to develop modified job duties when practical to facilitate early return to work
• Review pharmacy portal for medication management
• Educate injured workers on treatment plans as needed to enhance adherence to the treatment plan and monitor progress towards