Telephonic Nurse Case Manager - Workers' Compensation

General Summary:
 
In this work from home role, you will be responsible for completion of the ID15 intake process, medical case management of open high risk cases and integration of the RTW Solution with the employer. 

Key Responsibilities:
 
Complete ID15 intake on potential high risk claims:

1. Conduct ID15 online interviews with employer, injured worker and medical provider, following company standards for appropriate classification of high risk claims. 
2. Provide rigorous attempts to reach employer, injured worker and medical provider including sending correspondence if injured worker cannot be reached after several attempts.
3. Appropriately document all correspondence, contacts and actions on a claim in XCM per company standards.
4. Complete Risk Assessment and Obstacle and Strategy report to appropriate parties by product. 
 
In partnership with the account management team and/or claims team, participate in the development, implementation and ongoing refinement of the workers’ compensation return to work program for our customers:

1.  Establish a workers’ compensation program with customer including identification and coordination with medical providers, internal/external claims administrators and/or other external service providers. 
2. Coach customers to refine and improve their workers’ compensation program in areas of injury report filing and in coordination with loss prevention, supporting provision of transitional duty by assisting customers in identifying industry specific light duty options as needed.
3. Actively participate in strategy sessions, client check in meetings and/or dispute resolution meetings as requested.
 
Build a working relationship with all ID15 high risk injured workers, customers and medical providers:

1. Obtain treatment plan and facilitate injured worker’s return to work and adherence to their treatment plan.
2. Provide customers with a plan of action, regular communication, support on injured worker’s treatment plan, early return-to-work as soon as medically feasible and ongoing return-to-work progress.
3. Appropriately document all actions on a case.
4.  Appropriately close cases.
5. Ensure knowledge and execution of special handling instructions for assigned customers. 
  
Strategize with other associates (internal and external) to appropriately move the case towards resolution:

Minimum Experience / Education:

1. Education: Registered Nurse licensure.
2. Experience: Previous workers’ compensation and/or disability case management experience or Occupational health experience.

Communication and Collaboration Skills:
• Abilities: flexibility, customer focus, creativity and innovation, continuous learning. Maintain reasonable and predictable work attendance.
• Skilled in: personal leadership, relationship building, problem solving, planning and organization, conflict resolution, accountability, persuading and influencing.

Problem Solving:
• Knowledge of: medical diagnostics, procedures and treatment standards, occupational health and basic recovery theory, RTW/State Auto customer integration and management process, Account Management roles and responsibilities, claims roles and responsibilities, basic workers’ compensation and disability laws and rules.
• Skilled in: written and verbal communication, presentations, computer proficiency, customer service, problem solving, articulating workers’ compensation/disability benefits.
• Ability to: read and interpret medical records, articulate and enroll others into State Auto vision, philosophy, program components and requirements, and effectively coach and mentor associates. Maintain reasonable and predictable work attendance.

State Auto offers a competitive salary, an annual bonus program, an excellent benefit program including medical, dental, vision and prescription insurance coverage, life insurance, matching 401(k) plan, flexible spending accounts, tuition assistance, and a stock purchase plan.

State Auto is committed to the principal of equal employment opportunity for all associates and applicants and to providing associates with a work environment that is free from discrimination and harassment. All employment decisions (hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, training and work assignments) are based on business needs, job requirements and individual qualifications without regard to race, color, religion, gender, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, citizenship status, military status, or status as a covered veteran in accordance with applicable federal, state and local laws. State Auto will not tolerate discrimination or harassment based on any of these characteristics.

State Auto is a smoke-free work environment. We utilize drug screening and background checks as conditions of employment. For all exempt positions we also obtain motor vehicle reports (MVR s).

State Auto will not accept candidates from third-party recruiters without a signed agreement with State Auto.