RN Medical Case Manager - Workers Compensation
Company: The Travelers Companies, Inc.
Location: Rancho Cordova
Posted on: January 15, 2021
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Job Description:
Company SummaryTaking 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.Target Openings1Job Description SummarySolid reputation,
passionate people and endless opportunities. That's Travelers!Our
superior financial strength and consistent record of strong
operating returns mean security for our customers - and
opportunities for our employees. You will find Travelers to be full
of energy and a workplace in which you truly can make a
difference.If passion, reliability, and dedication are part of your
DNA, this is the job for you!Passion: You are passionate about
helping others and maintain a sense of urgency for our customers
when they reach out for assistance.Reliability: You combine
understanding with medical and technical skills to provide service
our customers know they can count on.Dedication: Your dedication is
clearly demonstrated throughout each phase of the workers'
compensation claims process.If you are looking for a job that
offers the same opportunity to make a difference without the
demands of working nights, weekends or holidays, you'll want to
explore your next move with us!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. As part of
the hiring process, this position requires the completion of an
online pre-employment assessment. Further information regarding the
assessment including an accommodation process, if needed, will be
provided at such time as your candidacy is deemed appropriate for
further consideration.Primary Job Duties & ResponsibilitiesContact
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) may be required
to comply with state and Travelers requirements. Generally,
license(s) must be obtained within three months of starting the job
and obtain ongoing continuing education credits as mandated.Minimum
QualificationsRegistered Nurse; Licensed Practical Nurse or
Licensed Vocational Nurse required.Education, Work Experience, &
KnowledgeRN highly preferredDisability case management experience
preferred.Prior clinical experience needed.Licensing or
CertificatesCertified Case Manager (CCM), Certified Disability
Management Specialist (CDMS), Clinical Research Counselor (CRC), or
Certified Rehab Registered Nurse (CRRN) preferred.Job Specific
Technical Skills & CompetenciesFamiliarity with URAC
standardsAnalytical 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.Environmental / Work Schedules / OtherTravel Requirements:
Travel OccasionallyEmployment PracticesTravelers is an equal
opportunity employer. We value the unique abilities and talents
each individual brings to our organization and recognize that we
benefit in numerous ways from our differences.If you have questions
regarding the physical requirements of this role, please send us an
email so we may assist you.Travelers reserves the right to fill
this position at a level above or below the level included in this
posting.
Keywords: The Travelers Companies, Inc., Rancho Cordova , RN Medical Case Manager - Workers Compensation, Healthcare , Rancho Cordova, California
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