Job: Nurse Case Manager

Company Overview SPECIALISTS IN THE INSURANCE INDUSTRY... Whether you are currently unemployed or just passively checking out the marketplace, we are the one staffing and recruiting firm with which you should consider a partnership. Our firm is constantly in contact with Insurance Professionals at every level across the United States in regards to the kinds of Insurance Talent we can provide to them. We have a strong reputation in matching your skills and work expectations to the job that is perfect for you.

Nurse Case Manager 11/21/2013 Apply Now >> Report this job  See all jobs at this company Printer-Friendly Version | Save this job | Email this job

Company: Q-Temps Contact: Kathy Gilman Location: Irving, TX (Map it!) Phone: Not Available Base Pay: $33.00 - $35.00 /Hour Fax: Not Available Employee Type: Contractor Email: Send Email Now Industry: Insurance Ref ID: QTEMPS - 9170 Manages Others: No Job Type: Nurse Insurance Req'd Education: High School Req'd Experience: At least 3 year(s) Req'd Travel: Not Specified Relocation Covered: Not Specified

Job Description Worker's Compensation - Nurse Case Manager TPA in Las Colinas in need of a Nurse Case Manager to work 2-3 days a week.  TPA handles Workers compensation claims nationwide with 1/3 of claims in CA and NY so experience with those states highly desirable.  DUTIES & RESPONSIBILITIES: Contact medical provider and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care. Develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management. Responsible for ongoing evaluation of treatment and return to work plan, within established protocols. Work with medical providers and suggest cost effective treatment alternatives, when appropriate. Help ensure that all injured parties are on an aggressive treatment plan. Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions. Perform Utilization Review according to established guidelines. Proactively manage the medical expenses by utilizing/referring files for (IME’s, Peer Reviews, Designated Doctor Evaluations, RME’s, UR’s, Medical Cost Projections, Drug Utilization Reviews, Field Case Management, etc…) to achieve appropriate claim outcomes Review all DDE reports, Peer Review Reports, IME Reports, DUR’s, MCP’s, UR’s, etc… and discuss with claims staff and management, when necessary, and make recommendations regarding medical care when appropriate Obtain medical records from providers telephonically during initial contact, and follow up with written correspondence if necessary. Discuss medical information and disability status with claim handler and integrate into overall strategy to ensure appropriateness of indemnity payments. Provide technical assistance and act as a resource for claim handling staff. Work with the claims staff & employer to initiate modified duty or full return to work. Obtain job description and discuss job modifications required to ensure a prompt return to work. Identify cases requiring task assignments to field case managers, discuss with supervisor for assignment to Medical or Vocational Case Manager, or vendor. Review all pre-authorizations that come through, in the applicable states where pre-auth is required, and ensure that ODG (Guidelines) are being followed & provide recommendations where necessary. Document all contacts and outcomes related to case activity in system. Perform other duties as required. Job Requirements Worker's Compensation - Nurse Case Manager 3+ Years handling Workers Compensation Cases as a NURSE CASE  MANAGER RN REQUIRED Worker Compensation experience REQUIRED Position is 2 days a WEEK (Client is flexible on Days) But days must be set Hours are 8 to 5 or 9 to 6

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