- Provides telephonic case management of associates with occupational illness/injuries to coordinate medical care.
- Addresses occupational injury/illness with the proactive component of aiding the associate in choosing a provider, or accessing Marriott's provider network/managed care network.
- Manages a jurisdiction of responsibility that may include multiple states.
- Conducts first level utilization review per jurisdictional requirements.
- Coordinates subsequent levels of utilization review if necessary.
- Identify and develop quality health care provider panels by building professional relationships with providers, ensuring that Marriott's policies of transitional duty and quality care are always adhered to.
- Maintain and update physician networks and panels.
- Collaborate with treating providers, working cooperatively for optimal outcomes.
- Arrange provider interface with business units and claims administration as needed.
- Contact injured/ill worker by telephone within 48 hours following assignment.
- Coordinate care, monitor progress, and facilitate prompt return to work when released to transitional duty.
- Serves as injured worker advocate assisting them to set goals and participate in their care.
- Recommend referral to Associate Resource Line as needed.
- Coordinate Work Hardening and Vocational Rehabilitation for injured workers per regional guidelines.
- Oversee Home Health and Field Case Managers.
- Collaborate with Claims department regarding case management.
- Collaborate with UNM on utilization review issues.
- Refer catastrophic cases in coordination with claims adjuster to outside rehabilitation or field case management and closely monitor for effective progress.
- Closes files per regional guidelines.
- Available to assist claims on informal review of litigated or lifetime medical claims to suggest course of action to move case forward.
- Maintain case load of claims most likely to benefit from case management to meet jurisdictional needs.
- Provide initial clinical review in order to certify care and services for injured workers.
- Provide formal level 1 utilization review and document in iVOS Medical Authorization Screen.
- Coordinate subsequent levels of utilization review per jurisdictional guidelines.
- Negotiate pricing for equipment and services per jurisdictional guidelines.
- Act as professional health resource for injured workers and managers.
- Provide triage service for business units following workplace illness/injury.
- Facilitate prompt return to work and transitional duty with managers.
- Provide consistent documentation that reflects all case management activities including medical, legal and ethical documentation requirements.
- Provide 90 day medical management reviews and discuss expectations and estimated length of exposure, recognize red flags and barriers to recovery.
- Maintain Registered Nursing license and advanced certification(s).
- Maintain continuing education units as necessary for certifications.
- Submit monthly and ad hoc reports as required.
- Must have at least five years nursing experience
- Effective reasoning, analysis and decision making skills
- Strong negotiation skills
- Strong organization skills
- Ability to prioritize work
- Ability to meet deadlines and follow up in a timely manner
- Thorough knowledge of claims process
- Present oneself with a positive, professional demeanor.
- Communicate often with supervisor keeping him/her informed
- Must be a licensed registered nurse
- Certification as an occupational health nurse and/or case manager (or, progress toward same) required
- Jurisdictional requirements for certifications must be met
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Staff Professional-Risk Mgmt - Dallas, United States - Marriott International
Description
Additional Information Nurse CARE Manager (CARE - Coordinated Action and Response)Registered Nurse license requiredJob Number
Job Category Finance & Accounting
Location Marriott International HQ, 7750 Wisconsin Avenue, Bethesda, Maryland, United States VIEW ON MAP
Schedule Full-Time
Located Remotely? Y
Relocation? N
Position Type Management
JOB SUMMARY
The Nurse CARE Manager coordinates timely, appropriate, quality, occupational illness/injury care and follow-up to ensure early return to work and to minimize workers' compensation losses.
The NCM is responsible for conducting first level Utilization Review and coordinates subsequent levels if necessary, as required by jurisdiction.
This position is responsive to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources.Quality, cost effective health services that meet the needs of the Marriott associates is a foremost concern in this position.
SCOPE/EXPECTED CONTRIBUTIONSScope
Providers
CANDIDATE PROFILE
Experience
California Applicants Only:
The salary range for this position is $72,600.00 to $155,197.00 annually.
Colorado Applicants Only:
The salary range for this position is $72,600.00 to $141,086.00 annually.
Hawaii Applicants Only:
The salary range for this position is $87,848.00 to $155,197.00 annually.
New York Applicants Only:
The salary range for this position is $72,600.00 to $155,197.00 annually.
Washington Applicants Only:
The salary range for this position is $72,600.00 to $155,197.00 annually. In addition to the annual salary, the position will be eligible to receive an annual bonus. Employees will accrue PTO balance for every hour worked and eligible to receive minimum of 7 holidays annually.
All locations offer coverage for medical, dental, vision, health care flexible spending account, dependent care flexible spending account, life insurance, disability insurance, accident insurance, adoption expense reimbursements, paid parental leave, educational assistance, 401(k) plan, stock purchase plan, discounts at Marriott properties, commuter benefits, employee assistance plan, and childcare discounts.
Benefits are subject to terms and conditions, which may include rules regarding eligibility, enrollment, waiting period, contribution, benefit limits, election changes, benefit exclusions, and others.
Marriott HQ is committed to a hybrid work environment that enables associates to Be connected.Headquarters-based positions are considered hybrid, for candidates within a commuting distance to Bethesda, MD; candidates outside of commuting distance to Bethesda, MD will be considered for Remote positions.
The application deadline for this position is 28 days after the date of this posting, 4/22/2024.Marriott International is an equal opportunity employer. We believe in hiring a diverse workforce and sustaining an inclusive, people-first culture.
We are committed to non-discrimination on any protected basis, such as disability and veteran status, or any other basis covered under applicable law.
Marriott International is the world's largest hotel company, with more brands, more hotels and more opportunities for associates to grow and succeed.
Be where you can do your best work, begin your purpose, belong to an amazing global team, and become the best version of you.
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