Senior Nurse Case Manager

Introduction

Looking to join a vibrant organization that makes a difference?

As part of the Church Mutual team, you'll work with some of the most experienced and knowledgeable people in the industry and achieve your own growth and career satisfaction while finding fulfillment in serving those who serve others. We foster a workplace where all employees are treated with dignity and respect; diversity, inclusion and belonging are woven into the fabric of our company through our customers, employees, leadership, business relationships and outreach programs. Join us and Stand for Good.

What you’ll be doing:

Responsible for assessing an injured worker’s case and course of medical treatment to evaluate the medical and vocational needs required to facilitate the patient's appropriate and timely return to work. Work collaboratively with claims staff, injured worker, employer, and health professionals to achieve optimal, cost effective medical and vocational outcomes. Assist in the review and oversight of workers compensation managed care vendors to ensure they are providing services in a timely, compliant, cost effective and appropriate manner.  Participate in claim resolution round tables, providing feedback, as necessary on medically based claim handling approaches. Potential supervisor responsibilities to include staffing, training and development, performance management, and work force planning as needed.

On any given day, you’ll:

• Assess cases promptly and identify cases that will benefit from task or long-term engagement, based on clinical presentation. Contact the injured worker, insured, and treating provider to understand the nature of the injury and the medical care required.
• Evaluate the injured employee's medical and vocational status and plan of care to facilitate the injured workers appropriate and timely return to work. Identify medical and return-to-work issues to optimize medical and disability care and costs.  Seek agreement from all parties throughout the continuum of care.
• Act as an advocate for the injured employee in the medical management process. As medically indicated, monitor, evaluate, and coordinate the delivery of high-quality, timely, and cost-effective medical treatment and other health services as needed by the injured employee to promote a prompt return to work.  Assist the injured employee in choosing a medical provider appropriate for the injury.  As needed, inform the employee of the list of network medical providers.
• Monitor and proactively resolve deviations from the treatment plan. Confer with specialists concerning course of care and treatment. Follow all laws and regulations that apply to rehabilitation services.
• As needed, facilitate communication between the provider, injured worker, and the claims handler to ensure medical care is clinically appropriate for the injury and there is a clear return to work plan in place as appropriate.
• As needed, Coordinate return-to-work activities with the injured workers supervisor, the Insured’s human resources department, the claim handlers, and others s as appropriate. At times, it may be necessary to work with the injured workers employer to identify a different role, or modified duty in their current role to meet the injured workers needs as part of a return to work plan.
• Participate in round tables, team and department meetings. Develop and provide required internal reports.
• Assist with Managed Care vendor oversight and reporting including but not limited to reviewing managed care invoices, assisting in the review of PPO and other managed care networks to optimize cost savings, and triaging issues with managed care vendor processes, portals or other concerns.
• Create account medical panel requests as needed.
• Serve as main point of contact in absence of Claim Manager.

Here’s what we expect

• Must hold a current and unrestricted registered nurse license in Wisconsin or Pennsylvania (dependent upon location), and California; and be able to obtain licensure for other states as required by law. A bachelor's degree in nursing or other related field is required.
• Professional certification of CCM, CDMS, CRRN, or COHN is a plus.
• Seven or more years of field case management experience required and extensive clinical nurse experience in the areas of orthopaedic, neurology, critical care, medical surgical, or rehabilitation required.
• Five or more years of California Nurse Case Management experience preferred.
• Workers' compensation, occupational health, or rehabilitation health experience preferred.
• Ability to work in an office environment that may be face to face with Adjusters, and/or virtually as required.
• Ability to work independently.
• Strong problem-solving and analytical skills.