The nurse case manager must be able to demonstrate and be accountable for the standards of practice policies and procedures, quality assurance and the goals of the organization. Also, manage treatment of claimants through the workers’ compensation system based on the individual’s diagnosis and state workers’ compensation regulations.

• Obtains and reviews patient clinical status and history to determine casual nature of patient’s symptoms as related to reported work injuries.
• Applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during the interview process, documentation and intervention with the claimant, their family or significant other.
• Determines the medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalizations.
• Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required. Communicates final decision and subsequent ramifications to claim handlers.
• Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers’ compensation, state, industry and division rating standards and policies, in conjunction with the claim handler.

• No prior experience is needed

• Opportunity to build a new category leader in healthcare services
• Competitive compensation including salary, stock options and benefits
• Collaborative, flexible work environment coupled with an uplifting culture
• Fully remote position