Nurse Care Manager Jobs

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 CONTRIBUTIONS

• Conducts first level utilization review per jurisdictional requirements.
• Provides telephonic case management of associates with occupational illness/injuries to coordinate medical care.
• Coordinates subsequent levels of utilization review if necessary.
• Manages a jurisdiction of responsibility that may include multiple states.
• 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.

Providers

• Arrange provider interface with business units and claims administration as needed.
• Maintain and update physician networks and panels.
• Collaborate with treating providers, working cooperatively for optimal outcomes.
• 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.

Injured Workers

• Recommend referral to Associate Resource Line as needed.
• Oversee Home Health and Field Case Managers.
• Coordinate care, monitor progress, and facilitate prompt return to work when released to transitional duty.
• Coordinate Work Hardening and Vocational Rehabilitation for injured workers per regional guidelines.
• Serves as injured worker advocate assisting them to set goals and participate in their care.
• Contact injured/ill worker by telephone within 48 hours following assignment.

Claims Services

• Collaborate with Claims department regarding case management.
• Maintain case load of claims most likely to benefit from case management to meet jurisdictional needs.
• Collaborate with UNM on utilization review issues.
• Closes files per regional guidelines.
• Refer catastrophic cases in coordination with claims adjuster to outside rehabilitation or field case management and closely monitor for effective progress.
• Available to assist claims on informal review of litigated or lifetime medical claims to suggest course of action to move case forward.

Utilization Review

• Coordinate subsequent levels of utilization review per jurisdictional guidelines.
• Provide formal level 1 utilization review and document in iVOS Medical Authorization Screen.
• Negotiate pricing for equipment and services per jurisdictional guidelines.
• Provide initial clinical review in order to certify care and services for injured workers.

Business Units

• Facilitate prompt return to work and transitional duty with managers.
• Provide triage service for business units following workplace illness/injury.
• Act as professional health resource for injured workers and managers.

Record Keeping/Documentation

• 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.

Education, Training and Licensure

• Maintain continuing education units as necessary for certifications.
• Maintain Registered Nursing license and advanced certification(s).

Reporting

• Submit monthly and ad hoc reports as required.

CANDIDATE PROFILE

Experience

• Must have at least five years nursing experience

Knowledge and Skills

• Thorough knowledge of claims process
• Effective reasoning, analysis and decision making skills
• Ability to prioritize work
• Communicate often with supervisor keeping him/her informed
• Strong organization skills
• Ability to meet deadlines and follow up in a timely manner
• Strong negotiation skills
• Present oneself with a positive, professional demeanor.

Education or Certification

• Must be a licensed registered nurse

• Jurisdictional requirements for certifications must be met
• Certification as an occupational health nurse and/or case manager (or, progress toward same) required

California Applicants Only: The salary range for this position is $70,838.00 to $151,428.00 annually.

Colorado Applicants Only: The salary range for this position is $70,838.00 to $137,661.00 annually.

New York City & Westchester County, NY Applicants Only: The salary range for this position is $85,714.00 to $151,428.00annually.

Washington Applicants Only: The salary range for this position is $70,838.00 to $151,428.00annually. In addition to the annual salary, the position will be eligible to receive an annual bonus. Employees will accrue 0.4616 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.