Clinic Nurse, Medical Case Manager – Workers Compensation

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Conduct face-to-face meetings with injured employees after office visits at a medical provider’s facility to support the claims process and ensure adherence to their medical treatment plan.

• Communicate with customers, medical providers, and injured parties regarding claims involving medical treatment and/or disability to coordinate suitable medical care and facilitate return to work.

• Formulate strategies to assist an injured employee's return to work and attain maximum medical improvement.

• Assess and update treatment and return to work plans in accordance with established protocols throughout the duration of the claim.

• Collaborate with medical providers to guarantee that the injured employee is actively engaged in an effective treatment plan.

• Review medical treatment requests to confirm that they are reasonable and necessary based on jurisdictional guidelines.

• Involve specialty resources as required to reach optimal resolutions (Dial-a-doc, physician advisor, peer reviews, MCU).

• Partner with Claim Professionals to provide essential medical information and disability status needed to create a comprehensive strategy for achieving optimal outcomes.

• Use internal Claim Platform Systems to manage all claim-related activities promptly.

• Utilize the Preferred Provider Network in line with jurisdictional guidelines.

• Collaborate with Claim Professionals to offer insights on medical treatment and recovery timelines to aid in assessing appropriate claim reserves.

• Submit precise billing documentation for all activities as specified in established guidelines.

• Engage with customers effectively.

• Participate in telephonic and/or onsite file reviews.

• Address inquiries, both oral and written.

• Keep the injured worker informed about the status of their claim.

⛳️ Requirements

• Registered Nurse (RN).

• Experience in disability case management.

• Previous clinical experience.

• Familiarity with URAC standards.

• Analytical Thinking: Recognizes current or future issues or opportunities; analyzes, synthesizes, and compares information to comprehend issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.

• Communication: Clearly and concisely expresses, summarizes, and documents thoughts both orally and in writing, applying appropriate content, format, sentence structure, grammar, language, and terminology.

• Capability to effectively present file resolutions to both internal and external stakeholders.

• Negotiation: Intermediate ability to understand alternatives, influence stakeholders, and reach fair agreements through discussion and compromise.

• General Insurance Contract Knowledge: Ability to comprehend policies and contracts as they relate to policy conditions.

• Principles of Investigation: Intermediate investigative capabilities.

• Value Determination: Basic ability to assess liability and assign a dollar value based on claimed damages and estimates, while setting and adjusting reserves.

• Legal Knowledge: Basic understanding and application of state, federal, and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other relevant regulations in the insurance sector.

• Medical Knowledge: Comprehensive understanding of the nature and extent of injuries, periods of disability, and required treatments.

• WC Technical: Intermediate ability to demonstrate knowledge of WC Products and utilize available resources and technology to manage treatment plans and aid in claim resolution. Clear understanding of jurisdictional parameters within the assigned state.

• Customer Service: Advanced ability to build and maintain productive relationships with insureds and deliver results that yield optimal outcomes.

• Teamwork: Advanced ability to collaborate effectively in situations where actions are interdependent, ensuring mutual responsibility for results.

• Planning & Organizing: Advanced ability to develop plans/course of action and contingencies for oneself or others to achieve current or future objectives.

• Certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN).

🏝️ Benefits

• Health Insurance: Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment.

• Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will contribute annually to your 401(k) account. You are also eligible for a Pension Plan that is fully funded by Travelers.

• Paid Time Off: Begin your career at Travelers with a minimum of 20 days of Paid Time Off annually, in addition to nine paid company holidays.

• Wellness Program: The Travelers wellness program offers tools, discounts, and resources that empower you to achieve your wellness goals and caregiving needs. Furthermore, our mental health program provides access to free professional counseling services, health coaching, and additional resources to support your daily life requirements.

• Volunteer Encouragement: We are deeply committed to the communities we serve and encourage our employees to engage. Travelers has a Matching Gift and Volunteer Rewards program that enables you to contribute to the charity of your choice.