Nurse Medical Case Manager - Workers Compensation - Walnut Creek, CA

Overview

Job Description ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

Who Are We? Taking care of our customers, our 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 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range
$85,600.00 - $

Target Openings
2

Under moderate supervision, provide office based telephonic medical case management with emphasis on 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 helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.

• Contact customer, medical provider 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. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
• Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
• Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
• Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
• Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
• Utilize Preferred Provider Network Per Jurisdictional Guidelines.
• Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
• Submit accurate billing documentation on all activities as outlined in established guidelines.
• Customer Engagement. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries – oral and written. Keep injured worker apprised of claim status.
• In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility.
• In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months.
• Perform other duties as assigned.

Minimum Education Required Associates

Job Category Management

Additional Qualifications/Responsibilities What Will Our Ideal Candidate Have? Disability…