Nurse Case Manager Job Charleston area,West Virginia USA,Nursing

The salary range for this job posting is $55,132.00 - $ annually + bonus + benefits.

Pay Type:

Salary The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process. Candidates who reside near our Charleston, WV office will work on average 1 day a week in the office.

However, we are open to considering candidates who can work remote in any of our listed payroll approved states. This role will report to a Director, Workers' Compensation Claims.

Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:
Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

JOB OBJECTIVE:

The Nurse Case Manager serves as an office-based skilled medical resource for the business teams. The position’s objective is to provide high quality customer service in workers' compensation medical case management and utilization review, primarily telephonically. The Nurse Case Manager provides medical expertise and serves a critical role in the cost containment of medical and indemnity expenses.

ESSENTIAL FUNCTIONS:

Complete early medical management assessment and intervention on workers' compensation claims requiring medical treatment. Contact injured workers and medical providers to obtain necessary information.

Apply knowledge, experience and evidence-based guidelines to evaluate claims and provide a proactive action plan.

Perform essential medical case management activities assessment, planning, implementation, monitoring and evaluation within accepted treatment guidelines.

Address medical cost containment through utilization management, collaboration with providers and assessing network resources.

Partner with appropriate team members to expedite injured worker recovery and return to work and to reduce disability costs.

Identify and monitor claims for task assignments to field case managers.

Evaluate accuracy of diagnoses of injuries or disabilities.

Document recommendations, contacts, actions and outcomes.

Adhere to jurisdictional regulations and standards.

Provide high quality customer service within a team-based environment.

OTHER FUNCTIONS:

Non-essential function: other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

Licensed Registered Nurse with no restrictions.
Minimum of an Associate degree in nursing from an accredited college or university or successful completion of a diploma nursing program required.
Bachelor’s or Master’s degree in nursing preferred.
One year of experience in nurse case management, medical case management, utilization review, vocational/disability case management required. Workers' compensation experience is strongly preferred.
Nationally recognized specialty certification in occupational or rehabilitative nursing or case management must be obtained as applicable, such as Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Registered Rehabilitation Nurse (CRRN), or Certified Occupational Health Nurse (COHN). National certification may substitute for one year of experience requirement.
Two years of clinical experience in orthopedics, neurology, rehabilitation, internal medicine, or occupational medicine is required.
Multi-state case management experience is desired.
Bilingual ability is a plus.
Ability to collect relevant information, establish facts, and draw relevant conclusions, and recommend effective solutions.
Working knowledge of evidence-based treatment guidelines, treatment protocols, medical causation and relatedness.
Ability to efficiently coordinate effective medical treatment while maximizing cost containment.
Ability to effectively collaborate with multiple team members and stakeholders.
Strong planning and organizing skills.
Working knowledge of the theory, principles, and practices of medical case management.
Ability to maintain knowledge of current trends and developments in the medical case management field.
Excellent oral and written communication skills.
Demonstrate diplomacy, compassion and professional competency.
Competent in Word, Outlook and Excel and capable of assimilating new systems applications and technology.
Ability to work effectively in a paperless environment.

This position has been evaluated in accordance with the Americans with Disabilities Act.

Encova Insurance makes every effort to reasonably accommodate…