What are the responsibilities and job description for the Onsite Nurse Case Manager (Hybrid/Remote) position at MEM?
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 determine whether this work is complete on-site or in a remote capacity.
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.
Case Management
- Accepts case management assignments based on own education, experience, and areas of expertise.
- Collects and assesses data from referral sources and medical treatment providers.
- Initiates either in-person or telephonic contact with the injured employee, policyholder, therapists, and medical providers as per claims standards.
- Coordinates and manages medical treatment plans for work injuries.
- Identifies services and treatment options that are medically necessary to promote quality care. Recommends a transfer of care when appropriate per state guidelines.
- Develops individualized medical treatment plans based on patient-specific needs.
- Identifies and explores gaps or inadequacies in treatment to prevent fragmented care.
- Directs care to in-network providers, vendors, and facilities.
Medical Documentation & Communication
- Maintains communication with all parties involved in the claim.
- Maintains and records case management activities.
- Documents activity on the medical management screen within the appropriate array in the Claims Center system.
- Accomplishes ongoing documentation per current claims standards.
- Communicates medical treatment plan activity and return-to-work issues with all parties.
- Includes estimated cost analysis when closing claims and documents realized cost savings.
- Maintains confidentiality of information and obtains appropriate consents/authorizations.
Return-to-Work Coordination
- Evaluates the injured worker’s potential for return to work, considering socio-economic factors, education, and vocational history.
- Establishes a return-to-work target date in collaboration with the injured worker, medical providers, and policyholder.
- Seeks light duty options to return the injured worker to safe, gainful employment as early as medically appropriate.
- In cases where return to the former job is not possible, makes recommendations regarding vocational rehabilitation to the claims representative.
- Makes appropriate recommendations and establishes achievable goals for all parties.
- Updates all participants as necessary regarding any treatment plan changes.
Collaboration & Advocacy
- Acts as an advocate for the patient’s needs within the workers’ compensation system.
- Establishes relationships with injured workers, their families/significant others, and medical providers to achieve optimal outcomes.
- Works closely with all parties to support maximum medical improvement while controlling costs and ensuring quality of care.
- Collaborates with the Nurse Case Management (NCM) team in alignment with MEM’s mission, vision, and values.
Professional Development & Representation
- Serves as a resource to claims representatives and other MEM staff members.
- Explains and demonstrates nurse case management programs to customers as requested.
- Acts as a mentor for less experienced and newly hired nurse case managers.
- Represents MEM in professional healthcare activities and internally.
- Attends conferences and seminars; participates in calls or meetings with policyholders or producers when requested.
- Utilizes resources such as the Medical Director, Utilization Management, and ODG as appropriate.
- Maintains a current file of articles, community resources, and in-service information related to nurse case management.
Administrative & Operational Tasks
- Calendar management, daily activities, and travel planning for appointments and medical treatment.
- Reviews and manages medical records and information.
- Handles interpersonal and written communication with all claim parties concerning medical treatment and return-to-work matters.
- Answers and returns telephone calls; sends and receives faxes and emails.
- Enters data into the claims system.
- Research medical information as needed.
- Participates in special projects as requested.
- Attends or presents information during staff meetings.
- Obtains continuing education units required for licensure and certification.
- Maintains ongoing communication with supervisor, providing updates during scheduled or impromptu meetings.
- Consults with supervisor on case direction or when sensitive issues arise.
QUALIFICATIONS:
Education
- Associate nursing degree/Graduate of a diploma RN program or bachelor’s degree in nursing
Designations/Certifications
- Certification in Case Management from Case Management Society of America is preferred.
Licenses
- Current unencumbered RN license from the Nebraska State Board of Nursing or an unencumbered RN license from a compact state (Missouri and/or Iowa)
- Current/Valid Driver’s License
Experience
- Three years of nursing experience is required in Medical/Surgical or related areas.
- Five years insurance case management experience preferred.
Skills
- Spanish bilingual 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.
