Clinic Nurse Medical Case Manager - Workers Compensation

Under moderate supervision, provide office based telephonic and/or in-person medical case management supporting Concierge locations with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations.

• Meet with injured employees face to face following office visits at a provider’s medical facility to assist with the claim process and ensure compliance with their medical treatment plan.
• Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.
• Develop strategies to facilitate an injured employee’s return to work and achieve maximum medical improvement.
• Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
• Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
• Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
• Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
• Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
• Utilize Preferred Provider Network per jurisdictional guidelines.
• Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
• Submit accurate billing documentation on all activities as outlined in established guidelines.

• RN preferred.
• Disability case management experience preferred.
• Prior clinical experience preferred.
• Familiarity with URAC standards

• Health Insurance
• 401k matching
• Paid Time Off
• Wellness Program
• Volunteer Encouragement

Taking care of our customers, our communities and each other. That’s the Travelers Promise.