Nurse Case Manager (Remote)

MEMIC is seeking a Registered Nurse to join our Managed Care Services department as a Nurse Case Manager. The Nurse Case Manager  utilizes their expertise to resolve workers’ compensation claims by working with the injured worker to provide proper, efficient, timely and cost-effective healthcare services. The Nurse Case Manager does this through the processes of evaluation, assessment, planning, and implementation with the ultimate goal leading to a medically rehabilitated individual ready to return to an optimal level of work and functioning.

• Conducts a comprehensive assessment of the injured worker physical and/or bio-psycho social needs in collaboration with the employer and medical provider to coordinate the medical care and return to work plan throughout the life of the claim.
• Acts as a liaison between the injured worker, the medical provider, the employer as to medical rehabilitation issues and return to work.
• Develops strategies to maximize medical outcomes in a cost effective manner.
• Coordinates with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
• Evaluates medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
• Works in collaboration with claim professionals as a medical resource to promote optimal outcomes.
• Engages specialty resources as needed to achieve optimal resolution.

Requirements:

• Bachelor’s Degree in Nursing preferred.
• Registered Nurse with current, valid New York state licensure required.
• Minimum of two (2) years direct clinical care to consumers, industrial rehabilitation and/or occupational health nursing preferred.
• Excellent communication (written and verbal), analytical and organizational skills are essential.
• Ability to identify and resolve problems in a timely manner, while able to gather and analyze information.
• Ability to demonstrate accuracy and thoroughness.
• Must have proficient computer skills, including Microsoft Office programs.
• Ability to set priorities and work independently is essential.
• Ability to effectively manage a minimum caseload of 35 files.