Nurse Case Manager

4 days ago

Roseville, United States Hanover Insurance Group, Inc. Full time

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey.

Our Claims department is seeking a Nurse Case Manager to join our growing team in our Roseville, CA office. Will consider qualified candidates who reside in CA and work remotely.

Position summary

Responsible to provide professional nurse case management coordination for claimants with compensable injuries. Participate collaboratively with various members of claims team, treatment providers, employers and network vendors. This is a Full-time, Non-Exempt role.

IN THIS ROLE YOU WILL
  • Monitors and evaluates claimants' responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
  • Collaborates with treatment providers and claimant for cost effective medical treatment Assists with removing roadblocks to treatment adherence by the claimant or insured party
  • Collaborates with claim handler for utilization review services as appropriate
  • Coordinates and monitors clinical treatment services such as discharge planning, medical specialty referrals, and vendor needs. This may include inpatient and outpatient services, MDs, home care, attendant care, and/or network partners for ancillary services
  • Evaluates the components of the injured/ill claimant's job with claimant and employer and if appropriate, clarifies the critical demands of the job and suggests any necessary modifications or accommodations to comply with government regulations (in WC/PIP claims) with a focus on ability and return to work
  • Educates and evaluates injured/ill claimant/class member, insured party, and health care provider regarding patient's response to treatment to enhance claimant adherence and progress toward maximum medical improvement as well as Return to Work planning
  • Coordinates and arranges for cost effective service delivery that is consistent with the claimant's health care requirements and policy benefits
  • Coordinates and monitors referrals to rehabilitation and medical case management vendors
  • Reviews and recommends need for an Independent Medical Exam, including area of medical specialty
  • Assists in projection of medical reserves for the life of the claim
  • Collaborates with PIP/WC teams for Roundtables
  • Maintain accurate and timely metrics including billing
  • Participate and prepare educational presentations to nursing peers and claims department staff as needed
  • Reports electronic data for utilization of NCM resources and claimant progress and outcomes with HIG guidelines and software programs.
WHAT YOU NEED TO APPLY
  • Registered nurse with current state licensure
  • Certified Case Manager certification
  • Minimum of three years of clinical experience in applicable nursing specialty field (ie occupational health, rehabilitation, orthopedics, home care, emergency, etc.)
  • Working knowledge of utilization review process, medical bill review and/or medical case management
  • Ability to collaborate and work effectively in a team environment
  • Strong analytical, problem solving and negotiation skills
  • Effective interpersonal communication and writing skills
  • Organization skills with regard to time management, task prioritization, and integration of information from a variety of sources
  • Ability to determine and meet internal and external customer needs
  • Word processing skills
  • Fluent in English
  • Knowledge of technical materials, rules, procedures or facts required to effectively performing the role such as : utilization criteria), medical coding mechanisms( ICD-9 CM, CPT-4, DSM-IV), case management standards of practice, state workers' compensation and personal injury protection (PIP) regulations
  • Ability to adapt to a dynamic work environment
  • PC/Keyboard skills.
Physical Demands and Work Environment
  • Ability to use a personal computer and other standard office equipment
  • Ability to sit and/or stand for extended periods
  • Required to work on-site as needed
  • Ability to travel as necessary
  • Ability to work hours in excess of 40 hours per week
  • Ability to work in a fast paced, changing or stressful environment
  • Ability to perform work in a noisy/loud work environment
CAREER DEVELOPMENT

It's not just a job, it's a career, and we are here to support you every step of the way. We want you to be successful and fulfilled. Through on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you - at every level - to grow and develop.

BENEFITS

We offer comprehensive benefits to help you be healthy, build financial security, and balance work and home life. At The Hanover, you'll enjoy what you do and have the support you need to succeed.

Benefits include
  • Medical, dental, vision, life, and disability insurance
  • 401K with a company match
  • Tuition reimbursement
  • PTO
  • Company paid holidays
  • Flexible work arrangements
  • Cultural Awareness Day in support of IDE
  • On-site medical/wellness center (Worcester only)
  • Click here for the full list of Benefits
EEO statement

The Hanover values diversity in the workplace and among our customers. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law.

Furthermore, The Hanover Insurance Group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law."

As an equal opportunity employer, Hanover does not discriminate against qualified individuals with disabilities. Individuals with disabilities who wish to request a reasonable accommodation to participate in the job application or interview process, or to perform essential job functions, should contact us at: (see below) and include the link of the job posting in which you are interested.

Privacy Policy

To view our privacy policy and online privacy statement, click here.

Applicants who are California residents: To see the types of information we may collect from applicants and employees and how we use it, please click here.

Other details

  • Job Function Claims
  • Pay Type Salary
  • Min Hiring Rate $85,000.00
  • Max Hiring Rate $100,000.00

Apply Now

  • California, USA
  • Roseville, CA, USA
  • Washington, USA

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