Nurse Medical Case Manager
5 months ago
Who Are We?
Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
Job Category
Claim, Nurse - Medical Case Manager
Compensation Overview
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Salary Range
$81, - $133,
Target Openings
1
What Is the Opportunity?
Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
What Will You Do?
Contact customer, medical provider 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. 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. Customer Engagement. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - oral and written. Keep injured worker apprised of claim status. In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months. Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Disability case management experience preferred. Prior clinical experience preferred. Familiarity with URAC standards Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions. Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work. Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed. WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred. Bilingual candidates encouraged to apply.
What is a Must Have?
Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.
What Is in It for You?
Health Insurance : Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment. Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
Employment Practices
Travelers is an equal opportunity employer. We believe that we can deliver the very best products and services when our workforce reflects the diverse customers and communities we serve. We are committed to recruiting, retaining and developing the diverse talent of all of our employees and fostering an inclusive workplace, where we celebrate differences, promote belonging, and work together to deliver extraordinary results.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
-
Nurse Medical Case Manager
4 weeks ago
Downers Grove, Illinois, United States 020 Travelers Indemnity Co Full timeJob Title: Nurse Medical Case ManagerAt Travelers, we're committed to delivering exceptional service to our customers and communities. As a Nurse Medical Case Manager, you'll play a critical role in ensuring that injured parties receive appropriate treatment and support to achieve maximum medical improvement.Key Responsibilities:Coordinate medical care and...
-
Clinical Case Manager
4 weeks ago
Downers Grove, Illinois, United States Integrated Resources Full timeJob Title: Clinical Case ManagerJob Summary:Integrated Resources is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will be responsible for conducting medical management and health education programs for customers on government health care programs. This role requires strong analytical and communication skills, as...
-
RN Case Manager
1 month ago
Downers Grove, United States Duly Health and Care Full timeOverviewRN Case Manager - Care Ally - Downers Grove Full-Time, 40 hours per week. Monday through Friday, 8:00 a.m. to 5:00 p.m.; flexibility to work later as needed Benefits: Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider....
-
Field-Based Case Manager RN
4 weeks ago
Downers Grove, Illinois, United States CVS Health Full timeJob SummaryThis is a field-based position with expected travel of 50-75% to meet with members face to face in Winnebago County, IL and surrounding areas. Strongly prefers candidates to reside in Rockford, IL area. Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.Job ResponsibilitiesAs a Nurse Case Manager, you will be responsible for...
-
Hospice RN Case Manager
1 week ago
Downers Grove, United States Lighthouse Hospice Full timeJob Type Full-time Description Sign-on Bonus! Lighthouse Hospice is driven to provide a professional hospice workplace where the employee is respected and valued. We recognize that creating a culture of trust, kindness and appreciation is required to retain the best talent, dedicated to making a difference in the lives of the people we serve. Our team...
-
Medical Management Specialist I
4 weeks ago
Downers Grove, Illinois, United States w3r Consulting Full timeThis position is responsible for conducting medical management and health education programs for customers on government health care programs. The role will include gathering, analyzing and providing data for regulatory reports. This position will represent the company to members.Job Purpose:This position is responsible for conducting medical management and...
-
Medical Management Specialist I
4 weeks ago
Downers Grove, Illinois, United States Integrated Resources Full timeJob Purpose:This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing data for regulatory reports. This position will represent the company to members.Key Responsibilities:* Conduct medical management and health...
-
Medical Case Management Specialist
4 weeks ago
Cottage Grove, Minnesota, United States LADGOV CORPORATION Full timeJob Title: Credentialing CoordinatorLocation: Cottage Grove ArmorySchedule: Monday through Friday, 06:00-17:00We are seeking a skilled Credentialing Coordinator to join our team at LADGOV CORPORATION. As a Credentialing Coordinator, you will be responsible for assembling and processing Mobility (MOB) packets for soldiers, managing medical waivers, and...
-
Medical Case Manager
1 month ago
Cottage Grove, Minnesota, United States LADGOV CORPORATION Full timeLADGOV CORPORATION seeks a skilled Medical and Dental Non-clinical Case Management and administrative Care Coordinator to support Individual Medical Readiness (IMR) in the Army National Guard. **Job Summary:**As a Care Coordinator, you will be responsible for assembling and processing Mobility (MOB) packets for soldiers, managing medical waivers, and...
-
Case Manager
2 months ago
Cottage Grove, United States Encompass Health Full timeCase Manager Career Opportunity Case Manager FT and PRN Recognized for your abilities as a Case ManagerAre you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on...
-
Registered Nurse
3 weeks ago
Maple Grove, United States St Croix Hospice Full timeRegistered Nurse (RN) Case Manager Job Details Level Experienced Job Location Maple Grove MN - Maple Grove, MN Education Level 2 Year Degree Job Shift Day Job Category Nurse Job Posting Date(s) Start Date 10/30/2024 Description TheRegistered Nurse Case Managerplans, organizes and directs hospice care and is experienced in nursing, with...
-
RN Case Manager
3 weeks ago
Grove City, United States Capital City Hospice – an Addus family company Full timeCapital City Hospice is seeking an RN Case Manager to join our team. We prioritize patient and family-centered care, with a focus on empowering our staff and providing manageable workloads and flexibility. As an RN Case Manager, you will be responsible for managing patient and family caseloads, coordinating care, and maintaining accurate patient records....
-
Case Management Licensed Vocational Nurse LVN
3 weeks ago
Pacific Grove, United States Del Monte Care Full timeBenefits: 401(k) matching Bonus based on performance Competitive salary Flexible schedule Free food & snacks Opportunity for advancement Paid time off Signing bonus Training & development Case Management / Licensed Vocational Nurse LVN Del Monte Village - Assisted Living and Memory Care Pacific Grove, Ca Full-Time Benefits Offered $33-$43 per hour Depending...
-
Medical Assistant
3 weeks ago
Downers Grove, United States Advocate Health Full time$2,500 SIGN ON BONUS FOR EXTERNAL CANDIDATES ONLY Major Responsibilities: Performs all the functions of a Medical Assistant I Med Grp such as preparing and rooming the patient, clinical integration focus, performing laboratory procedures, assisting the Physician/Advanced Practice Clinician (APC) with procedures and administering routine medications, under...
-
Case Manager RN
2 weeks ago
Garden Grove, United States Providence Full timeDescriptionCare Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts.Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent...
-
Case Manager RN
1 month ago
Garden Grove, United States Providence Full timeDescription Care Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts. Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent...
-
Case Manager RN
3 weeks ago
Garden Grove, United States Providence Full timeDescription Care Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts. Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses...
-
Case Manager RN
3 weeks ago
Garden Grove, United States Providence Full timeDescription Care Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts. Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent...
-
Case Manager RN
2 weeks ago
Garden Grove, United States Providence Full timeDescription Care Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts. Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses...
-
Case Manager RN
2 weeks ago
Garden Grove, United States Providence Full timeDescriptionCare Manager RN at St Joseph Hospital-Orange in Orange, CA. Positions available are either Full Time or Per Diem, Day shifts.Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent...
