Managed Care Network, Inc., (MCN) is a growing company headquartered in Niagara Falls, New York, which offers claim administration support services to Property & Casualty Insurance Carriers throughout New York State.

MCN strives to be the best in the P&C marketplace by providing our customers with responsive service, innovative solutions, and high-quality outcomes. We take pride in our work and our company, and for being viewed as a reliable and dependable partner to our customers. We value our customers each and every day and in everything we do.

JOB SUMMARY:

The Claims Review Nurse works as part of a multidisciplinary team and Assesses Disability, Impairment, and treatment for Workers Compensation Cases based upon the unique details of each case and how they align with the New York State Workers Compensation Impairment and Treatment Guidelines.

This position is within MCN’s claims department and will require the individual to work closely with physicians, attorneys, claim adjusters, and other staff, in a collaborative manner. The ideal candidate should be able to work independently and as a team, value quality work, and hold themselves to high ethical standard.

Initial training will be provided and is ongoing.

However, the successful candidate must be a Registered Nurse.

JOB DUTIES:

• Reviewing medical records;
• Compiling chronologies and analyzing pertinent treatment and medical records;
• Understanding New York State Workers Compensation Medical Treatment Guidelines;
• Understanding New York State Workers Compensation Impairment Guidelines;
• Correctly applying regulations and guidelines to specific scenarios;
• Drafting various reports, letters, and/or other communication;
• Contacting medical offices, claimants, employers, and various other individuals;
• Maintaining required processes to ensure quality standards are maintained;
• Presenting findings to the Medical Director, Legal, and other team members; and
• Being able to testify, under oath, regarding medical findings and analysis.

EXPERIENCE:

Preferred not required

• Physician’s office
• Claims experience with an insurance company
• New York State Workers Compensation
• New York State Workers Compensation Medical Treatment Guidelines
• Nurse/Medical Case Management
• Utilization Review
• Utilization Management

NECESSARY SKILLS:

• Attention to Detail;
• Computer skills;
• Analytical and communication skills;
• The ability to adapt and quickly develop an understanding of new or changing rules, regulations, and/or laws;
• An ability to prioritize different workloads;
• Time management;
• The ability to work independently, while meeting deadlines and providing status updates as indicated;
• The ability to multi-task; and
• The ability to work collaboratively, as part of a team.

Job Type: Full-time

Pay: $70,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off

Standard shift:

• Day shift

Weekly schedule:

• Monday to Friday

Work Location: In person