Telephonic Nurse Case Manager

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.

The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker’s compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risks on behalf of the Company.

Creates and manages worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

• Performs initial and ongoing clinical assessment via telephone calls to relevant parties that may include the injured worker, physician, attorney or other parties.
• Assesses client’s situation for psychosocial needs, cultural implications and ensures support systems are in place.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• Monitors ongoing progress toward established goals and objectives.
• Implements plan through case management interventions and communication with all parties to reach desired goals and objectives.

Measures effectiveness of treatment plans and creates alternate strategies when needed.

• Recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
• Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
• Negotiates and coordinates a prompt return to work with employer.
• Measures and reports on interventions to determine the outcome of the case manager’s involvement to include clinical, financial, variance, quality of life, and client satisfaction.
• Maintains accurate record of management including costs, savings and demographic data.

Communicates effectively with all parties involved in injured worker’s treatment.

• Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
• Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.
• Maintains injured worker’s privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards.
• Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
• May perform Utilization Review activities (or review information coming through a vendor partner); presents reports to clients and providers.

This role does not have supervisory responsibilities.

Associate’s or Bachelor’s degree from four-year college or university in Nursing preferred. Equivalent combination of education and experience may be considered. Minimum 2 years of professional experience providing direct clinical care required. Case Management in WC, Discharge Planning, or Home Health preferred.

Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required. Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.

Working knowledge in direct clinical care required. Ability to work with medical and mathematical concepts such as diagnoses, probability and statistical inference. Ability to compute mathematical frequency and percentages. Ability to apply principles of logical, sound judgment or medical thinking to…