Nurse Case Manager

Nurse Case Manager

Remote

Clear Spring Property and Casualty is a leading provider of property and casualty insurance. Our future-forward strategy is rooted in deep industry knowledge and a mastery of emerging technologies. Clear Spring Property and Casualty Company is a subsidiary of Delaware Life Insurance Company and its parent company, Group1001. Our relationship with these organizations has yielded an innovative technology platform that provides smarter risk management solutions for property and casualty insurance brokers. Clear Spring is dedicated to Group1001's mission: making insurance more useful, intuitive, and accessible for everyone. Were confident in our forward-thinking products, and that youll love partnering with us.

Job Summary

The Nurse Case Manager will be responsible for working with the claims department and vendor partners to coordinate medical treatment for injured workers and claimants by assessing, planning, coordinating, implementing, and evaluating injuries resulting from automobile and workers compensation accidents. They will also work as a liaison with medical providers and other relevant stakeholders to provide medical treatment analysis, recommendations, status reports, and best practice solutions.

Main Accountabilities

• Collaborate with internal and external claims teams to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers compensation, personal injury protection (no fault), and liability.
• Evaluate medical records for mechanism of injury and appropriate utilization of medical treatment and services.
• Identify opportunities, develop, and implement new clinical programs as well as improve existing programs and procedures.
• Assist in developing and maintaining vendor and adjuster expectations and relationships.
• Negotiate rates with local healthcare providers including nursing homes, sub-acute facilities, and attendant care agencies.
• Prepare and deliver training to claims staff.
• Assist with other duties within the team or elsewhere, on request.
• Maintain current knowledge of regulatory environment and emerging safety issues.

Qualifications

• Active RN license in good standing required, BSN highly preferred.
• Certification in Case Management (CCM) required or to be obtained within 18 months of hire.
• Minimum of three to five years clinical experience required. Strong clinical background in orthopedics, neurology, rehabilitation, or trauma care is preferred. Insurance experience a plus.
• Minimum of five years experience as a nurse case manager.

• Previous case management experience dealing with PIP, Workmans Compensation, managed care, home care and/or rehabilitation is preferred.
• Previous hospital experience may include Critical Care, Emergency Room, and/or Orthopedics is required.
• Knowledge of discharge planning and home care is preferred.

• Ability to work independently and effectively in a team environment.
• Ability to communicate effectively in oral and written forms, read and interpret documents, and write routine reports and correspondence. Proficient computer skills including Microsoft Office products. Teaching or training experience a plus.
• Excellent problem resolution skills. This person should be able analyze details, make decisions, demonstrate innovativeness, and continually seek more efficient ways to process and handle work for the benefit of the team.
• Excellent organizational skills with the ability to manage multiple priorities.