Nurse Medical Case Manager - Workers Compensation - Franklin, TN

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

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 170 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.

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.

Annual base salary range: $85,600.00 – $. Employees also eligible for performance‑based cash incentive awards.

• 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.
• 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.
• Perform other duties as assigned.

• Disability case management experience.
• Prior clinical experience.
• 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…