RN Case Manager - Workers' Compensation

Reporting directly to the Medical Management Supervisor, the Workers' Compensation (WC) Case Manager supports the WC Department by following the best practices associated with managing of the injured worker effectively and efficiently.

The position requires the nurse to work and communicate with other members of the Medical Management team in addition to the WC Claims team, WC Claims Supervisors, and other team members.

Essential Duties and Responsibilities:.

• Demonstrate knowledge, skills, and competency in the application of case management standards of practice.

• Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs.

• Facilitate the Injured Worker’s rehabilitation by coordinating medical treatment, advocate for the Injured Worker with all medical providers and stakeholders and educate the Injured Worker on their recovery process.

• Understand, apply, and comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review, case management, and medical management.

• Evaluate the appropriateness, medical need and efficiency of health care procedures and facilities according to established criteria or guidelines.

• Effectively communicate and collaborate with management, peers, and colleagues to ensure alignment, compliance and effective management of assigned claims.

• Participate and/or support identified project initiatives

• Proactively seek development opportunities and identify business process improvements to maximize effectiveness of operations and minimize cost.

Required Qualifications:

• RN required

• Minimum of 5 years of clinical nursing experience required

• WC/PIP experience preferred

• Bachelor of Science in Nursing (BSN) is preferred.

• Certified Case Manager (CCM) beneficial.

• Strong internal and external relationship management skills

• Detail oriented with exceptional time management and organizational skills.

• Ability to work independently and in a team environment

• Proactive

• Willingness to learn and grow within the position

• Demonstrate reliability and conform to the company’s attendance policy

• Intermediate Microsoft Office Suite skills (Outlook, Word, Excel, PowerPoint) with ability to navigate technology and multiple systems effortlessly.

• High School Diploma or Equivalent

Compensation: Salary is commensurate with experience and credentials.