Onsite Nurse Case Manager (Remote)

Are you driven to keep people safe? That's what we do every day at MEM Insurance.

We've created a casual, values-driven work culture that's making a positive impact on the way people live and work. This is a place where you can grow with confidence - because that's what safety and success really mean to us.

SUMMARY:

The role of the Case Manager is to assure that patients have access to quality, cost effective heath care, and to assist in the assessment, development, and coordination of a proactive plan to ensure the best outcome for the work injury. The role of case manager addresses early return to work and coordinates the return to work with the policyholder, the treating physician, and the claims representative. The nurse case manager will facilitate a safe, effective, early return to work. These job duties are accomplished primarily through ongoing personal contact with all parties. Discretion may be used to

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties or audits may be assigned such as audits requiring a physical visit to the policyholder's location in proximity to the Premium Consultant's location.

Collects/assesses data from referral source and medical treatment providers.

Identifies and screens potential cases for possible case management based on MEM step criteria for case management referral.

Initiates either personal contact with the injured employee, policyholder, therapists, and medical providers as per the claim's standards.

Initiates and develops ongoing communication with providers of treatment to promote quality care that is medically necessary, for the best possible outcome for the work injury.

Coordinates and manages medical treatment plan.

Obtains detailed initial health history and from injured worker.

Obtains detailed job description from injured worker and policyholder

Identifies services and treatment options medically necessary to provide/promote quality care for the work injury.

Reviews treatment plan with all involved participants

Acts as advocate for patient's needs when indicated within the confines of the workers compensation system.

Identifies and explores gaps or inadequacies in treatment plan to avoid fragmented medical treatment.

Develops individual medical treatment plan for specific patient's needs.

Maintains confidentiality of information and obtains appropriate consents/authorizations.

Evaluate the injured worker's potential for return to work and how that may impact the rehabilitation process. Taking into consideration socio-economic factors, education, and vocational history

In cooperation with the medical service providers, the injured worker, and the policyholder, establish a return-to-work target date. Wherever possible and consistent with sound medical judgment, search for light duty options to return the injured employee to safe, gainful employment as soon as possible.

Establishes relationship with injured worker, family, and medical providers to achieve optimal outcomes.

Work closely with all parties to effect maximum medical improvement while controlling costs and maintaining quality of care.

Maintains communication with all the parties involved in the claim.

Makes appropriate recommendations and establishes achievable goals for all parties to the claim.

Updates all participants as necessary regarding any treatment plan changes.

Maintains and records case management activity.

Documents activity on the medical management screen within the appropriate array within the ClaimsCenter system

Accomplishes ongoing documentation within the current claim's standard.

Communicates activity concerning the medical treatment plan.

and early return to work issues to all parties involved in the

claim

Includes accurate cost analysis when closing claim to nurse case management and documents cost savings when realized.

Maintains ongoing communication with supervisor.

Updates supervisor in meetings, as scheduled or impromptu meetings, regarding any injured workers status

Consults with supervisor when direction is required on a case or when sensitive issues regarding the case or injured worker arise.

Represents MEM in professional activities in the health care community, and internally.

Attends conferences, seminars, and when requested, performs calls/meetings with policyholders or producers.

Works with claims representatives and other staff members to discuss or educate on them on the concepts of nurse case management.

Explains and demonstrates nurse case management programs to customers, as requested.

Acts as a mentor for less experienced and newly hired nurse case managers.

Obtains and utilizes information pertaining to all facets of position responsibilities.

Keeps a current file of articles, community resources and in-service information pertaining to nurse case management and health care resources.

Attends, or is responsible, for presenting information when asked during staff meetings.

Calendar/daily activities/travel for appointments/medical treatment

Reviewing/management of medical records and information

Interpersonal/written communication between all parties of the claim concerning medical treatment/return to work.

Coordinates/manages medical treatment plan for the work injury.

Early return to work issues for the injured worker

Communication with supervisor/manager

Obtaining continuing educations units required for licenses/certifications. QUALIFICATIONS:

Education:

Associate nursing degree/Graduate of a diploma RN program or Bachelors' Degree in nursing

Certification in Case Management from the Case Management Society of America or similar certification or eligibility to obtain.

Licenses:

Current unencumbered RN license from the Missouri State Board of Nursing or an unencumbered RN license from a compact state

Current/Eligibility for Missouri State Driver's license

Designations/Certifications:

Certification in Case Management from Case Management Society of America is preferred.

Experience:

At least three years of nursing experience is required in Medical/Surgical areas.

A background in Home Health is applicable.

Five years insurance case management experience preferred.

TOTAL REWARDS:

Health Plans: Medical, Dental, and Vision

Our medical plan includes robust offerings such as fertility benefits and fully paid preventative care.

Our dental coverage also includes adult orthodontia, and other less commonly covered dental treatments.

Fully Employer-Paid Life and Disability Benefits

Life Insurance - three times base salary

Accidental Death and Dismemberment

Short and Long-term Disability

Employee Wellness and Recognition Program with employer-paid incentives for employees and their spouses

Flexible Spending Account and Dependent Care options

Health Savings Account with generous employer contribution

Time Away from Work

Generous PTO accruals

11 Holidays and 4 Early releases

16 Hours of Volunteer Time Off

20 days of paid parental leave (in addition to STD)

Marriage, Bereavement, and Jury Duty leave policies

Employee Assistance Programs

401k Retirement Plan including employer match and profit sharing

Adoption Assistance

Tuition Assistance

Our home office is located in vibrant Columbia, Missouri - #6 in Livability's 2019 Best Places to Live.