Workers Compensation Nurse Case Manager

Brighton Health Plan Solutions
Chapel Hill, NC
Category Human Resources
Job Description
The Workers' Compensation Nurse Case Manager collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan.

Requirements

  • Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work.
  • Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines.
  • Knowledgeable and compliant with New York State Workers' Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process.
  • Proven ability to anticipate claimant's treatment or recovery milestones.
  • Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives.
  • Facilitates and expedites discharge planning as needed.
  • Produces accurate electronic records of individual cases.
  • Ensures timely, cost-effective medical care for injured workers' recovery.
  • Answers provider calls and assists with Casualty Department workload as necessary.
  • Kind, caring, and positive with all customers and fellow employees.
  • Adheres to established quality assurance standards and MagnaCare policies and procedures.

Benefits

  • Paid Time Off
  • Retirement Plan
  • Tuition Reimbursement
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