Telephonic Nurse Case Manager
Core
Assess, develop, implement, monitor, and evaluate care plans to optimize claimant health; coordinate care delivery among providers, agencies, and families; provide medical expertise in injury claim investigations and resolutions.
Role type
Senior IC nurse case manager (insurance)
Builds
Optimized care plans and resolved injury claims (workers' comp, PIP, liability)
Domain
Insurance / Healthcare / Rehabilitation
Required skills
Case management process, care plan development, care coordination, medical record evaluation, claims investigation, vendor relationship management, rate negotiation, clinical program development
Preferred skills
Orthopedics, neurology, rehabilitation, or trauma care background; insurance experience; training/teaching experience
Technologies
Microsoft Office, WebEx
Responsibilities
Coordinate care delivery and support among claimant support systems; Collaborate with claims associates to provide medical expertise in injury claims; Evaluate medical records for relatedness to injury and appropriate utilization of services; Prepare and deliver trainings to claims staff; Identify opportunities, develop, and implement new clinical programs; Negotiate rates with local healthcare providers
Seniority
Mid-Senior level, hands-on IC