Workers Compensation Nurse Case Reviewer

1 month ago

New York, New York, United States Brighton Health Plan Solutions, LLC Full time
Job Title: Workers Compensation Nurse Case Reviewer

About the Role:

Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers' Compensation and other Casualty clients. The Workers Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Reviewer reports to the Casualty Department Manager.

Key Responsibilities:

  • Collaborate with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work.
  • Provide utilization review, continued stay reviews, and utilization management based on clinical judgment and state WCB Medical Treatment Guidelines.
  • Stay knowledgeable and compliant with New York State Workers' Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process.
  • Anticipate claimant's treatment or recovery milestones and provide proactive case management.
  • Assess barriers to recovery and determine treatment alternatives, ensuring timely and cost-effective medical care for injured workers.
  • Facilitate and expedite discharge planning as needed, ensuring seamless transitions.
  • Produce accurate electronic records of individual cases, maintaining high-quality documentation.
  • Ensure compliance with established quality assurance standards and MagnaCare policies and procedures.
  • Participate in up to 10% of employed time in QA activities, contributing to continuous improvement.

Essential Qualifications:

  • Currently licensed Registered Nurse (RN)
  • Maintain current licensure(s) and specialty certifications relevant to this position, with CCM encouraged.
  • Bachelor's degree preferred, with a minimum of 4 years' experience in a clinical environment required.
  • Previous workers' compensation case management experience is essential, with previous experience in utilization review/medical management preferred.
  • Strong medical assessment and medical record review skills are necessary, along with excellent customer service skills.
  • Ability to define and solve problems, collect data, establish facts, and make effective decisions is crucial.
  • Detail-oriented and organized, with strong time management skills and the ability to work independently.
  • Proficient in using a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel, and Outlook.

About Brighton Health Plan Solutions:

At Brighton Health Plan Solutions, LLC, our people are committed to improving how healthcare is accessed and delivered. We value diversity, inclusion, and a sense of belonging at every level. Our team is dedicated to bringing outstanding products and services to our partners, transforming the health plan experience, and redefining health care quality and value.

Company Mission:

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision:

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement:

We encourage all team members to bring their authentic selves to work, respecting how they experience the world and welcoming them to bring the fullness of their lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion, and a sense of belonging at every level.

Equal Opportunity Employer:

We are an Equal Opportunity Employer, committed to creating a diverse and inclusive work environment.

  • Registered Nurse Case Manager

    4 weeks ago

    New York, New York, United States Spectrum Healthcare Resources Full time

    Job Title: Registered Nurse Case Manager - Workers' Compensation SpecialistSpectrum Healthcare Resources is seeking a skilled Registered Nurse to join our team as a Case Manager for injured federal workers. As a key member of our team, you will be responsible for creating and managing return-to-work care plans for workers experiencing time loss due to...

  • Worker's Compensation Paralegal Specialist

    1 month ago

    New York, New York, United States Trandon Associates, Inc Full time

    Job OverviewTrandon Associates, Inc is seeking a highly skilled and bilingual Worker's Compensation Paralegal to join our team.The ideal candidate will possess excellent communication skills, a strong work ethic, and the ability to manage a large case load.Key Responsibilities:Maintain contact with claimants to gather medical, employment, and wage...

  • Senior Worker's Compensation Attorney

    4 weeks ago

    New York, New York, United States Trandon Associates, Inc Full time

    Job DescriptionTrandon Associates, Inc is seeking a highly skilled Workers Compensation Attorney to represent client interests at depositions and counsel clients on emerging issues in litigated matters. The ideal candidate will have 1 + year experience with NYC worker's compensation cases and be barred to practice in NYC. Responsibilities include preparing...

  • Senior Workers Compensation Attorney

    3 weeks ago

    New York, New York, United States Trandon Associates, Inc Full time

    Trandon Associates, Inc is seeking a highly skilled Senior Workers Compensation Attorney to represent client interests at depositions and counsel clients on emerging issues in litigated matters.Responsibilities:Prepare exposure analysis and conduct settlement negotiationsConsistently apply firm standards and tactics to achieve client goalsRequirements:Must...

  • Senior Case Reviewer

    4 weeks ago

    New York, New York, United States City of New York Full time

    The City of New York is seeking a highly skilled and detail-oriented Senior Case Reviewer to join our team in the Department of Social Services Accountability Office (DSS-AO). As a Senior Case Reviewer, you will be responsible for conducting legally mandated case reviews to ensure compliance with lawsuit stipulations, settlements, and agreements.Key...

  • Senior Case Reviewer

    3 weeks ago

    New York, New York, United States City of New York Full time

    Job SummaryThe City of New York is seeking a highly skilled and detail-oriented Senior Case Reviewer to join our team. As a Senior Case Reviewer, you will be responsible for conducting legally mandated case reviews to comply with lawsuit stipulations, settlements, and agreements. You will also be responsible for compiling findings into reports that are...

  • Litigation Associate

    4 weeks ago

    New York, New York, United States Lexitas Legal Talent Outsourcing Full time

    NY Workers' Compensation Defense Litigation OpportunityLexitas Legal Talent Outsourcing is seeking a Litigation Associate to join their NYC team. This role will focus on NY Workers' Compensation defense matters.Key Responsibilities:Defend clients in NY Workers' Compensation casesCollaborate with the team to develop defense strategiesConduct research and...

  • Paralegal - Workers' Compensation Defense Specialist

    4 weeks ago

    New York, New York, United States Quintairos, Prieto, Wood & Boyer, P.A. Full time

    Job SummaryQuintairos, Prieto, Wood & Boyer, P.A. is seeking a highly skilled Paralegal to support our Workers' Compensation Defense team in our New York City office. This is a full-time position offering a competitive salary and comprehensive benefits package.ResponsibilitiesInvestigate facts and law of cases, searching public records and pertinent sources...

  • Attorney Workers' Compensation Specialist

    4 weeks ago

    New York, New York, United States Quintairos, Prieto, Wood, & Boyer, P.A. Full time

    Job Summary:Quintairos, Prieto, Wood & Boyer, P.A. is seeking a skilled Attorney Workers' Compensation Specialist to join our NY office. The ideal candidate will have 2+ years of experience in Workers' Compensation law.Key Responsibilities:Review and prepare summaries of medical recordsPrepare motions, cover hearings, and prepare clients for...

  • Workers Compensation Underwriting Assistant

    4 weeks ago

    New York, New York, United States Justworks Full time

    About the RoleWe are seeking a detail-oriented and analytical Workers Compensation Underwriting Assistant to join our team at Justworks. As a key member of our underwriting team, you will play a critical role in evaluating workers' compensation insurance risks and ensuring that our clients receive the best possible coverage.Key ResponsibilitiesReview...

  • Telecommute Medical Review Specialist

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job Summary:Concentra is seeking a skilled Neurologist to join our medical review team as a Telecommute Medical Review Specialist. In this role, you will review health claims and provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals.As a Telecommute Medical Review Specialist, you will...

  • Workers' Compensation Attorney

    4 weeks ago

    New Hyde Park, New York, United States VECCHIONE VECCHIONE CONNORS & CANO Full time

    Job DescriptionVecchione, Vecchione, Connors & Cano, LLP, is seeking a skilled Workers' Compensation Attorney to join our team. The ideal candidate will have experience handling hearings and depositions, and will be licensed to practice in New York. Responsibilities include day-to-day case handling, dictating and drafting correspondence to clients, and...

  • Quality Control Case Review Supervisor

    4 weeks ago

    New York, New York, United States City of New York Full time

    Job Summary: We are seeking a highly skilled Quality Control Case Review Supervisor to join our team at the City of New York. As a key member of our Quality Assurance & Fiscal Integrity team, you will be responsible for supervising and guiding Quality Control Case Reviewers in conducting reviews for the Enhanced Quality Assurance System (EQAS) and the State...

  • Telecommute Medical Review Physician

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job Title: Telecommute Medical Review PhysicianJob Summary:Concentra is seeking a Telecommute Medical Review Physician to join our team. As a Telecommute Medical Review Physician, you will review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term...

  • Telecommute Medical Review Physician

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job Summary:We are seeking a skilled and experienced Internal Medicine Physician to join our medical review team as a telecommute reviewer. As a reviewer, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and long-term...

  • Telecommute Medical Review Physician

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job Summary:Concentra is seeking a skilled Telecommute Medical Review Physician to join our team. As a Telecommute Medical Review Physician, you will review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave...

  • Senior Case Reviewer

    4 weeks ago

    New York, New York, United States City of New York Full time

    Job SummaryWe are seeking a highly skilled and experienced Senior Case Reviewer to join our team at the City of New York. As a Senior Case Reviewer, you will be responsible for conducting legally mandated case reviews to ensure compliance with various lawsuit stipulations, settlements, and agreements. You will also be responsible for converting audit...

  • Telecommute Medical Review Physician

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job Summary:Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.This telecommute role...

  • Telecommute Medical Review Stream Physician

    4 weeks ago

    New York, New York, United States Concentra Full time

    Job SummaryConcentra is seeking a Telecommute Medical Review Stream Physician to join our team. As a Telecommute Medical Review Stream Physician, you will be responsible for reviewing medical files and providing recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term...

  • Case Manager

    1 month ago

    New York, New York, United States QBE The Americas Full time

    About the RoleWe are seeking a skilled Case Manager to join our Workers' Compensation team in Perth, WA. As a key member of our team, you will be responsible for delivering an exceptional customer experience journey through managing the end-to-end claims process, ensuring a smooth return to work and recovery for the injured person and by providing support...