Senior Nurse Case Manager

Found in: Lensa US P 2 C2 - 2 weeks ago

Atlanta, United States Builders Full time

Senior Nurse Case Manager

Excellence. Trust. Mutual Respect.

Do these words resonate with you? If so, Keep reading and apply below

These values of Builders culture create success in all we do. We strive to provide deeply supportive partnerships to our customers, agents, and each other.

Builders is proud to be named one of the top workplaces USA with top marks in Company Direction, Employee Appreciation, Work-Life Balance, Leadership, and Compensation and Benefits. Our strong culture keeps us Built Strong in a forever-changing world, and our AM Best A Rating is evidence of our financial strength.

Summary of the role:

Senior Nurse Case Manager is responsible for acting as liaison between all parties involved in the management of work-related injuries. Primary role is to control costs and length of disability through the monitoring of all medical aspects of the claim by implementing the nursing process which includes assessment, planning, coordination, intervention and evaluation.

What would be your day in the life at Builders?

  • Managing case load and provide initial contact on all assigned lost time files within 24 hours and provide complete early intervention report within 30 days
  • Inputting pertinent data and recommendations electronically on all assigned cases and bills
  • Assisting in the pre-certification process, recommending any diagnostic tests and procedures for medical review and medical necessity
  • Coordinating and scheduling IME or second opinion appointments as needed, as well as all authorized medical treatments and appointments
  • Maintaining contact with the injured worker, employer, and adjuster as often as needed, to ensure that the treatment plan is understood and improvement is being made
  • Maintaining communication between all parties involved in treatment plan (i.e. physician, therapist, etc.)
  • Contacting and obtaining approval for injured worker contact on all represented cases as requested by the Adjuster
  • Consulting with Supervisor on all cases that have been recommended for referral to a contract rehabilitation nurse
  • Making recommendations for referral to field case management on all cases meeting criteria
  • Providing medical updates after each appointment, including review of progress, change in work status and change in treatment plan
  • Providing early intervention on all assigned cases
  • Providing monthly MR status reports addressing medical progress, treatment plan, RTW/Vocational issues and projected date of MMI
  • Assisting in negotiating pricing for medical equipment, supplies and/or treatment as needed
  • Coordinating return to work with adjuster and employer
  • Providing recommendations based on the assessment of medical reports, evaluating for appropriate care and the claimants progress to recovery
  • Keeping abreast of any changes in procedures or handling of cases as well as Workers Comp. State laws.
  • Ability to adhere to attendance guidelines
  • Additional duties and projects as assigned

What skills will you need?

  • Bachelor's degree from an accredited college or university in Nursing
  • Registered Nurse license
  • Certification preferred - CRRN, CCM
  • 10 years of clinical nursing experience
  • 3 or more year of workers compensation case management experience
  • Utilization Review experience preferred
  • Ability to evaluate situations and make appropriate recommendations
  • Strong verbal and written communication skills
  • Ability to work with internal and external customers
  • Strong analytical, decision making and negotiation skills
  • Self-motivated and flexible with ability to work independently
  • Strong customer service, problem solving, interpersonal and organizational skills
  • Strong verbal and written communication skills
  • Ability to learn new software systems and programs
  • Ability to multi-task, plan and focus on detail
  • Ability to maintain the highest level of confidentiality
  • Ability to interact with individuals at all levels, inside and outside of the company
  • Computer literate; advanced Microsoft Office skills

Lets talk benefits

  • Competitive Salary
  • Bonus Structure
  • Profit Sharing
  • Medical, Dental, Vision Insurance
  • Employer Paid Short Term Disability
  • Employer Paid Long Term Disability
  • Employer Paid Life Insurance
  • Voluntary Life Insurance
  • 401K with Company Match
  • PTO

About Builders

Builders is a mid-sized mutual with remarkable strengths. Rated A by AM Best, Builders has forged rock-solid financial strength and a reputation for reliability and fairness in fulfilling our promises to customers. Kind, collaborative, and customer-centric, our experienced and passionate teams foster a rewarding atmosphere of excellence, trust, and mutual respect, meriting the Culture Excellence honors from Top Workplaces. Flexible and highly personal, our experts leverage deeply supportive partnerships with knowledgeable independent agencies to drive better services and protection for policyholders.

Our financial excellence, amazing people, and powerful partnerships build outstanding outcomes and peace of mind for our agents and their clients. This is what we mean by Insurance Built Strong.

by Jobble

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