Telephonic Nurse Case Manager

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.

The Telephonic Nurse Case Manager will perform clinical assessments and evaluate needs for treatment in worker’s compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risk on behalf of the Company.

WHAT YOU WILL DO

Creates and manages worker’s compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

• Assesses client's situation for psychosocial needs, cultural implications and ensures support systems are in place.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• Performs initial and ongoing clinical assessment via telephone calls to the injured worker, employer, physician and attorney.
• Monitors ongoing progress toward established goals and objectives.
• Implements plan through case management interventions and communication with all parties to reach desired goals and objectives.

Measures effectiveness of treatment plans and creates alternate strategies when needed.

• Recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
• Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
• Measures and reports on interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction.
• Maintains accurate record of management including costs, savings and demographic data.
• Negotiates and coordinates a prompt return to work with employer.

Communicates effectively with all parties involved in injured worker’s treatment.

• Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
• Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
• Performs Utilization Review activities and reviews timely reports with clients and providers.
• Maintains injured worker's privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards.
• Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.

WHAT YOU BRING TO THE ROLE

• Equivalent combination of education and experience may be considered.
• Associate's or Bachelor’s degree from four-year college or university in Nursing preferred.
• Minimum 2 years of professional experience providing direct clinical care required.

CERTIFICATES, LICENSES, REGISTRATIONS

• Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.
• Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required.

KNOWLEDGE AND SKILLS

• Ability to work with medical and mathematical concepts such as diagnoses, probability and statistical inference.
• Ability to apply principles of logical, sounds judgement or medical thinking to a wide range of intellectual and practical problems.
• Working knowledge in direct clinical care required.
• Ability to compute mathematical frequency and percentages.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, injured workers and members of the business community.
• Ability to hypothesize on root cause of inefficiencies in treatment and then articulate probable solutions.
• Ability to read, analyze, and interpret documents such as medical reports and health information of all types, industry journals, and legal documents.

COMPENSATION

The salary range listed for this position, $74,932.01 to $126,367.76, is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors such as skills, experience and/or education. In addition, we believe in the importance of pay equity and consider internal equity of our current team members as part of any final offer. We typically do not hire at the maximum of the range in order to allow for future and continued salary growth. We also offer a substantial benefits package outlined below.

WHY JOIN ICW GROUP?

• Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
• 10 paid holidays throughout the calendar year
• Challenging work and the ability to make a difference
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
• Want to continue learning? We’ll support you 100%
• Bonus potential for all positions
• You will have a voice and feel a sense of belonging

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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