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Nurse Case Manager (Remote Potential)
Weehawken , NJ 07086
Posted 2 months ago
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MEMIC is seeking a Registered Nurse to join our Managed Care Services department as a Nurse Case Manager. The Nurse Case Manager utilizes their expertise to resolve workers compensation claims by working with the injured worker to provide proper, efficient, timely and cost-effective healthcare services. The Nurse Case Manager does this through the processes of evaluation, assessment, planning, and implementation with the ultimate goal leading to a medically rehabilitated individual ready to return to an optimal level of work and functioning.
- Conducts a comprehensive assessment of the injured worker physical and/or bio-psycho social needs in collaboration with the employer and medical provider to coordinate the medical care and return to work plan throughout the life of the claim.
- Acts as a liaison between the injured worker, the medical provider, the employer as to medical rehabilitation issues and return to work.
- Develops strategies to maximize medical outcomes in a cost effective manner.
- Coordinates with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
- Evaluates medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
- Works in collaboration with claim professionals as a medical resource to promote optimal outcomes.
- Engages specialty resources as needed to achieve optimal resolution.
- Bachelors Degree in Nursing preferred.
- Registered Nurse with current, valid state licensure required.
- Minimum of two (2) years direct clinical care to consumers, industrial rehabilitation and/or occupational health nursing preferred.
- Excellent communication (written and verbal), analytical and organizational skills are essential.
- Ability to identify and resolve problems in a timely manner, while able to gather and analyze information.
- Ability to demonstrate accuracy and thoroughness.
- Must have proficient computer skills, including Microsoft Office programs.
- Ability to set priorities and work independently is essential.
- Ability to effectively manage a minimum caseload of 35 files.