Clinic Nurse Medical Case Manager - Workers Compensation

Clinic Nurse Medical Case Manager - Workers Compensation

• 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.
• Participate in Telephonic and/or onsite File Reviews.
• Respond to inquiries – oral and written.
• Keep injured worker apprised of claim status.

• RN
• Disability case management experience
• Prior clinical experience
• 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.