Overview

At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs, rewarding and recognizing individual and team efforts. Certified as a Great Place To Work, our employee satisfaction and retention ranks in the 95th percentile.

Reasons you should consider a career with CCMSI:

• Culture: Our Core Values are embedded into our culture of how we treat our employees as a valued partner-with integrity, passion and enthusiasm.
• Career development: CCMSI offers robust internships and internal training programs for advancement within our organization.
• Benefits: Not only do our benefits include 4 weeks paid time off in your first year, plus 10 paid holidays, but they also include Medical, Dental, Vision, Life Insurance, Critical Illness, Short and Long Term Disability, 401K, and ESOP.
• Work Environment: We believe in providing an environment where employees enjoy coming to work every day, are provided the resources needed to perform their job and claims staff are assigned manageable caseloads.

The Nurse Case Manager is responsible for comprehensive case management of assigned case files, acting as a resource for all involved parties. Creates flexible, cost effective options for work-injured individuals to facilitate quality of care, to create individualized treatment goals, and to achieve the best possible outcomes. Responsible for assuring the claimants’ care is appropriate, cost effective and leads toward rapid and safe return to work and maximum medical improvement.

Responsibilities

• Reviews all assigned files to assess the claimant’s medical needs, work status and present condition in order to develop and document an action plan for each referred claim.
• Acts as a facilitator to injured worker, employer, provider, adjuster, and attorney where allowed, fostering non-adversarial relationships while moving towards maximum medical improvement, safe early return to work, and file closure. The case manager monitors treatment and works in conjunction with the adjuster in accordance with CCMSI’s claims management guidelines and utilization management programs.
• Reviews all medical records/documentation for medical necessity and appropriateness of care. Works with all parties involved in the management of the claim to formulate a plan for rapid, safe, and whenever possible, early return to work. Documents cost savings and bills accurately for all work performed
• Participates in problem solving to develop an effective strategy for claim closure.
• Maintains the file in accordance with CCMSI’s claims handling guidelines and incorporates the essential activities of case management as defined by his/her Certification guidelines throughout the medical case management process on each file.
• Develops the medical case management plan for each claim in conjunction with the adjuster. Each managed claim should contain individually focused, functionally oriented treatment plans. Maintains a close working relationship with all parties involved in the claim as allowed per state jurisdiction.
• Makes recommendations for referrals when necessary and appropriate, for independent medical evaluation, treatment, consultation, second opinion, site evaluations, etc
• Supports and fosters a team building environment for all internal and external customers, assuring that their needs are met in a timely and efficient manner.
• Performs other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent verbal and written communication and interpersonal skills required.
• Ability to manage multiple and changing priorities with skill and dignity.
• Attention to detail, planning and documentation.
• Discretion and confidentiality is a must.
• Knowledge of case management philosophy, process, outcomes and goals.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing both internally and externally.

Education and/or Experience

RN preferred BSN 3-5 years of clinical experience related to Trauma, Rehabilitation Therapy, Orthopedics, Workers’ Compensation Occupational Medicine Medical Surgical.

Computer Skills 

Proficient with Microsoft Office programs. 

Certificates, Licenses, Registrations 

Current Jurisdictional Nursing license required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Object Handling Categories

Work requires the ability to lift/carry objects routinely as follows:

Light Lifting: No lifting of objects weighing more than 15 pounds on a regular basis.

Work requires the ability to sit or stand up to 7.5 or more hours at a time.

Work requires sufficient auditory and visual acuity to interact with others.

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefit package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP and 401K.