- Meet with injured employees face to face after office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan.
- Contact customers, medical providers, and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
- Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement.
- Coordinate with medical providers to ensure the injured employee is actively involved in a viable treatment plan.
- Evaluate medical treatment requests to ensure their reasonableness and necessity based on jurisdictional guidelines.
- Engage specialty resources as needed for optimal resolution.
- Partner with Claim Professional to provide medical information necessary for an optimal outcome.
- Utilize internal Claim Platform Systems for timely claim activities.
- Utilize Preferred Provider Network per guidelines.
- Partner with Claim Professional to provide input on medical treatment and recovery time for appropriate claim reserves.
- Submit accurate billing documentation as outlined.
- Engage in customer service, participate in file reviews, respond to inquiries, keep the injured worker updated on claim status.
- Acquire and maintain necessary Insurance License(s) and/or certifications as required.
- Perform other assigned duties.
- RN preferred.
- Disability case management experience preferred.
- Prior clinical experience preferred.
- Familiarity with URAC standards.
- Various skills including analytical thinking, communication, negotiation, insurance contract knowledge, investigation principles, value determination, legal knowledge, medical knowledge, WC technical skills, customer service, teamwork, planning, organizing, and relevant certifications.
- Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.
- Health Insurance: Coverage for employees and eligible family members from the first day of employment.
- Retirement: Travelers matches 401(k) contributions up to 5% of eligible pay with additional benefits for student loan repayment and a fully funded Pension Plan.
- Paid Time Off: Minimum 20 days Paid Time Off annually, plus company Holidays.
- Wellness Program: Tools, discounts, and resources to support wellness goals and mental health needs.
- Volunteer Encouragement: Matching Gift and Volunteer Rewards program to give back to the community.
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Clinic Nurse Medical Case Manager - Morristown, United States - Travelers
Description
Who Are We? Taking care of our customers, communities, and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture rooted in innovation and thriving on collaboration. Imagine loving what you do and where you do it.
Job Category Claim, Nurse - Medical Case Manager
Compensation Overview The annual base salary range for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary will be determined by factors including scope, complexity, location of the role, skills, education, training, credentials, experience, and other employment conditions. Employees are also eligible for performance-based cash incentive awards as part of our comprehensive compensation and benefits program.
Salary Range $81,000 - $133,000
Target Openings 1
What Is the Opportunity? Under moderate supervision, provide office-based telephonic and/or in-person medical case management support for Concierge locations emphasizing early intervention, return-to-work planning, coordination of quality medical care on claims involving disability and medical treatment, as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for ensuring injured parties receive appropriate treatment related to the compensable injury or assisting claim handlers in managing medical treatment to a resolution. This position will work at a concierge Concentra Clinic in Parsippany, NJ.
What Will You Do?
What Will Our Ideal Candidate Have?
What is a Must Have?
What Is in It for You?
Employment Practices Travelers is an equal opportunity employer that values diversity and fosters an inclusive workplace to deliver excellent products and services. We celebrate differences, promote belonging, and work towards extraordinary results.
