Medical Case Manager

3 days ago


Paris, Île-de-France, United States Travelers Insurance Company Full time

About Us

At Travelers Insurance Company, we are dedicated to providing exceptional care to our customers, communities, and employees. Our commitment to innovation and collaboration drives us to deliver extraordinary results.

About the Job

We are seeking a skilled Registered Nurse (RN) or Licensed Practical Nurse (LPN) / Licensed Vocational Nurse (LVN) to join our team as a Medical Case Manager in our Concierge Location Support role. This position involves working with injured employees to ensure they receive the necessary medical treatment and support for a timely return to work.

Key Responsibilities

  • 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 customers, medical providers, 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.
  • C 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.

Requirements and Qualifications

  • Bachelor's degree in Nursing (BSN) or higher required; registered nurse license (RN) or licensed practical nurse/licensed vocational nurse (LPN/LVN) certification required.
  • Prior clinical experience preferred.
  • Familiarity with URAC standards and knowledge of WC products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution desired.
  • Ability to communicate effectively with diverse stakeholders, including injured employees, medical providers, and claim professionals, in a fast-paced environment.
  • Excellent analytical, problem-solving, and negotiation skills, with the ability to adapt to changing circumstances.
  • Strong understanding of disability management principles and practices, including early intervention, return-to-work planning, and medical case management.
  • Knowledge of insurance contracts, policies, and procedures, with the ability to interpret and apply relevant laws and regulations.

What We Offer

We offer a competitive salary of $83,300.00 - $137,400.00 per year, plus benefits such as health insurance, retirement plans, paid time off, and wellness programs. Join our team today and be part of a dynamic organization that values diversity, inclusion, and community engagement


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