27,385 Medical Case Management jobs in the United States

Overview

PRIMARY PURPOSE:

The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker’s compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years’ experience overseeing a nursing claims management program as well as in-depth understanding of worker’s compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical treatment and engagement of the injured worker to achieve a safe and reasonable return to work. This position requires interaction with physicians, other medical providers, claims professionals, supervision, injured employees and employers.

Responsibilities

• Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers.
• Responsible for all oversight of operational and administrative activities within the department/unit.
• Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded.
• Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff.
• Management of performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions.
• Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations.
• Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level.
• Ensures appropriate compliance with all legislation, corporate policies, and programs.
• Assist Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews.
• Implements new and revised policies and procedures.
• Performs additional duties and/or is assigned special projects as requested.

Qualifications

Education & Licensing

• Ability to develop, manage and direct an office/unit operation and effectively communicate operational procedures to field/unit staff.
• Demonstrated leadership and innovation in achieving results.
• Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies.
• Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required.
• Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
• National Certification in case management OR the ability to obtain certification within 24 months of employment is required. 
• Written and verbal fluency in Spanish and English preferred.

Experience

• Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management.  
• Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience.

Skills & Knowledge: 

• Knowledge of workers' compensation laws and regulations 
• Knowledge of case management practice
• Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
• Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
• Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitationKnowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation  skills Ability to work in a team environment Ability to meet or exceed Performance Competencies 

The salary range for this role is $108,000-$120,000/year. This range is only applicable for jobs to be performed in New York. Base pay offered may vary depending on, but not limited to education, experience, skills, geographic location, travel requirements, sales or revenue-based metrics. This range may be modified in the future.

#LI-GH1

#LI-HYBRID

#AmTrust

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Overview

PRIMARY PURPOSE:

The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker’s compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years’ experience overseeing a nursing claims management program as well as in-depth understanding of worker’s compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical treatment and engagement of the injured worker to achieve a safe and reasonable return to work. This position requires interaction with physicians, other medical providers, claims professionals, supervision, injured employees and employers.

Responsibilities

• Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers.
• Responsible for all oversight of operational and administrative activities within the department/unit.
• Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded.
• Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff.
• Management of performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions.
• Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations.
• Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level.
• Ensures appropriate compliance with all legislation, corporate policies, and programs.
• Assist Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews.
• Implements new and revised policies and procedures.
• Performs additional duties and/or is assigned special projects as requested.

Qualifications

Education & Licensing

• Ability to develop, manage and direct an office/unit operation and effectively communicate operational procedures to field/unit staff.
• Demonstrated leadership and innovation in achieving results.
• Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies.
• Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required.
• Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
• National Certification in case management OR the ability to obtain certification within 24 months of employment is required. 
• Written and verbal fluency in Spanish and English preferred.

Experience

• Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management.  
• Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience.

Skills & Knowledge: 

• Knowledge of workers' compensation laws and regulations 
• Knowledge of case management practice
• Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
• Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
• Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitationKnowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation  skills Ability to work in a team environment Ability to meet or exceed Performance Competencies 

The salary range for this role is $108,000-$120,000/year. This range is only applicable for jobs to be performed in New York. Base pay offered may vary depending on, but not limited to education, experience, skills, geographic location, travel requirements, sales or revenue-based metrics. This range may be modified in the future.

#LI-GH1

#LI-HYBRID

#AmTrust

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Description

About Us

Quality Medical Management partners with attorneys, doctors, and patients to coordinate medical care for personal injury cases. Our Case Managers guide patients through treatment while keeping attorneys and providers updated.

We are seeking detail-oriented Case Manager Assistants to support our Case Managers by handling administrative and follow-up tasks, allowing them to focus on patient and attorney relationships.

Applicants should be extremely thorough, possess excellent communication skills, and have some background in customer service. Send us your resume today to become part of the team!

Responsibilities

Requirements
• Strong organizational skills with extreme attention to detail.
• Prior experience in medical records, legal support, case management, or healthcare admin preferred.
• Excellent written and verbal communication.
• Persistent and proactive - won't let requests sit unanswered.
• Comfortable making calls and following up with providers' offices.
• Proficient with Google Workspace (Docs, Sheets, Gmail) and case management software.
• Reliable internet and availability during U.S. business hours.

What We're Looking For
• A support-focused team player who takes pride in keeping cases running smoothly.
• Someone who can juggle multiple tasks while staying organized.
• A problem-solver who escalates issues quickly rather than letting them stall.
• Long-term commitment - we want to invest in people who grow with our team.

Compensation
• Hourly rate based on experience.
• Potential for growth into senior administrative or case management roles.

Qualifications

• Navigates computer programs with ease to provide a quick front-desk experience for customers
• High school diploma or GED required
• Customer service, bookkeeping, or administrative experience is preferred
• Proven track record of completing projects on time in an orderly manner
• Enjoys talking with customers and can communicate through verbal and written channels

**Who Are We?**

Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.

**Job Category**

Claim, Nurse - Medical Case Manager

**Compensation Overview**

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

**Salary Range**

$83,300.00 - $137,400.00

**Target Openings**

1

**What Is the Opportunity?**

Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.

**What Will You Do?**

+ Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.

+ Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.

+ Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.

+ Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.

+ Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).

+ Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.

+ Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.

+ Utilize Preferred Provider Network per jurisdictional guidelines.

+ Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.

+ Submit accurate billing documentation on all activities as outlined in established guidelines.

+ Customer Engagement.

+ Participate in Telephonic and/or onsite File Reviews.

+ Respond to inquiries - oral and written.

+ Keep injured worker apprised of claim status.

+ In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility.

+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months.

+ Perform other duties as assigned.

**What Will Our Ideal Candidate Have?**

+ Disability case management experience preferred.

+ Prior clinical experience preferred.

+ Familiarity with URAC standards

+ Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.

+ Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.

+ Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.

+ General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions.

+ Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work.

+ Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.

+ Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.

+ Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.

+ WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.

+ Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.

+ Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.

+ Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.

+ Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.

**What is a Must Have?**

+ Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.

**What Is in It for You?**

+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.

+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.

+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.

+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.

+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

**Employment Practices**

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.

Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit .

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range
$83,300.00 - $137,400.00

What Is the Opportunity?
Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
What Will You Do?
Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.
Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
Utilize Preferred Provider Network per jurisdictional guidelines.
Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
Submit accurate billing documentation on all activities as outlined in established guidelines.
Customer Engagement.
Participate in Telephonic and/or onsite File Reviews.
Respond to inquiries - oral and written.
Keep injured worker apprised of claim status.
In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility.
In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months.
Perform other duties as assigned.
What Will Our Ideal Candidate Have?
Disability case management experience preferred.
Prior clinical experience preferred.
Familiarity with URAC standards
Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions.
Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work.
Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.

Additional Qualifications/Responsibilities

What Will Our Ideal Candidate Have?
Disability case management experience preferred.
Prior clinical experience preferred.
Familiarity with URAC standards
Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions.
Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work.
Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.
What is a Must Have?
Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.

**Who Are We?**
Taking care of our customers, our communities and each other. That's the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it.
**Job Category**
Claim, Nurse - Medical Case Manager
**Compensation Overview**
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
**Salary Range**
$83,300.00 - $137,400.00
**Target Openings**
1
**What Is the Opportunity?**
Under moderate supervision, provide office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
**What Will You Do?**
+ Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.
+ Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
+ Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
+ Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
+ Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
+ Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
+ Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
+ Utilize Preferred Provider Network per jurisdictional guidelines.
+ Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
+ Submit accurate billing documentation on all activities as outlined in established guidelines.
+ Customer Engagement.
+ Participate in Telephonic and/or onsite File Reviews.
+ Respond to inquiries - oral and written.
+ Keep injured worker apprised of claim status.
+ In-person medical case management may be required to support Concierge locations, where a Nurse Case Manager meets with injured employees face to face following office visits at a provider's medical facility.
+ In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months.
+ Perform other duties as assigned.
**What Will Our Ideal Candidate Have?**
+ Disability case management experience preferred.
+ Prior clinical experience preferred.
+ Familiarity with URAC standards
+ Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making.
+ Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders.
+ Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise.
+ General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions.
+ Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work.
+ Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves.
+ Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry.
+ Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
+ WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state.
+ Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes.
+ Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result.
+ Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals.
+ Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN) preferred.
**What is a Must Have?**
+ Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.
**What Is in It for You?**
+ **Health Insurance** : Employees and their eligible family members - including spouses, domestic partners, and children - are eligible for coverage from the first day of employment.
+ **Retirement:** Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers.
+ **Paid Time Off:** Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays.
+ **Wellness Program:** The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs.
+ **Volunteer Encouragement:** We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.
**Employment Practices**
Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.
In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.
If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email ( ) so we may assist you.
Travelers reserves the right to fill this position at a level above or below the level included in this posting.
To learn more about our comprehensive benefit programs please visit .

**Description**
Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.
UNC Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve a diverse patient base, spanning Nash, Edgecombe, Halifax, Wilson Counties, and beyond. With a steadfast commitment to elevating community health through exceptional care, we prioritize excellence, compassion, and innovation, ensuring every individual receives the highest standard of support. Joining our team means becoming an integral part of our dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this transformative journey, where your contributions will make a lasting impact on our community's health and wellbeing.
Summary:
Plans schedule and organizes patient care in mobile clinic setting. Assist nurses and physicians with procedures. Performs general office duties. Connects patients with resources to maintain health and wellbeing.
Responsibilities:
1. Displays a professional manner and image. Demonstrates initiative and responsibility. Works as a member of the health care team. Prioritize and performs multiple tasks. Treats all patients with compassion and empathy. Adapts communications to individual's ability to understand.
2. S upports existing health services; provides integrated health services in partnership with other health professionals; extends access to health services delivery in underserved and general populations, including primary care, public health, disease management, prevention and wellness, mental health, and dental health; and performs other duties as required.
3. Uses professional telephone techniques. Practices institutions attendance policies. Makes every attempt to work as requested during unusual circumstances or natural disasters.
4. Prepare and maintain medical records. Prepare and maintain examination and treatment areas. Perform inventory of supplies and equipment. Independently schedules appointments. Files daily medical charts.
5. Accurately dictates telephone prescriptions to a pharmacy. Coordinates patients' referrals and follow-up visits per physicians' instructions. Assists physicians with receiving any further needed patient records. Identifies potential changes/needs in physician's schedule.
6. Applies principles of aseptic technique and infection control. Collects and processes specimens. Obtains patient history and vital signs. Setup/clean patient rooms. Prepare patient for examination, procedures, and treatments. Coordinate patient care information with other health care providers. Documents according to policy.
Other information:
**Education Requirements:**
+ High school graduate or GED.
+ Completion of NC Standard Core Competency training for Community Health Workers within 6 months of hire
**Licensure/Certification Requirements:**
+ Certified Medical Assistant
+ BLS
+ Community Health Worker Certification within 6 months of hire
**Professional Experience Requirements:**
+ 2 years in the Healthcare/Medical - Certified Medical Technician (CMT)
**Job Details**
Legal Employer: Nash Hospitals
Entity: Nash UNC Health Care
Organization Unit: NGH Case Management
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Assignment Type: Onsite
Work Schedule: Day Job
Location of Job: NASH HC
Exempt From Overtime: Exempt: No
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Salary: 50, ,284.00 USD

Facility: Sisters of Charity Hospital

Shift: Shift 1

Status: Full Time FTE:

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days with Weekend and Holiday Rotation

Hours:

Primary 8-4pm with rotation to 10-6pm

Summary:

The social worker, as an active member of the Care Management and interdisciplinary care team provides comprehensive social work and discharge services to patients and families in the hospital setting. Utilizing foundational social work and discharge planning principles, the social worker engages the patient/patient representative in developing and implementing a post hospital plan that best meets their health and psychosocial needs.

Responsibilities:

EDUCATION

• Bachelors of Social Work (B.S.W.) from a school accredited by the Council on Social Work Education preferred or

• Masters of Social Work (M.S.W) from a school accredited by the Council on Social Work Education with a baccalaureate in another field

• New York State Screen certification preferred

EXPERIENCE

• One year experience as a social worker in a health or health related field or

• One (1) academic year experience as a social work intern in an acute hospital, medical rehab unit, primary care setting or sub-acute unit in a nursing home

KNOWLEDGE, SKILL AND ABILITY

• Possess solid social work skills in engagement, assessment, and planning and those critical to working on an interdisciplinary care team

• Has a good understanding of the Social Determinants of Health (SDOH)

• Has good knowledge of types of services within the immediate community and able to do a variety of methods to locate those not easily identifiable

• Has good ability to organize, prioritize, and manage work in a fast paced hospital environment

• Possesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and software

WORKING CONDITIONS

• Varied hours and days at times to meet the needs of patients and families and of the Care Management Department

• May be required to work at other Catholic Health hospital sites as needed

• Variable schedule which may include weekends and holidays

ENVIRONMENT

• Normal heat, light space, and safe working environment typical of most office jobs; and

• Occasional exposure to one or more mildly unpleasant physical conditions

• Significant amount of walking within the acute care facility

REQNUMBER: 37882

Medical Coordination Assistant

Every person deserves compassion, dignity, and the safety of a place to call home. Homelessness is the largest social and public health crisis in California. Illumination Health + Home is a growing non-profit organization dedicated to disrupting the cycle of homelessness by providing targeted, interdisciplinary services in our recuperative care centers, emergency shelters, housing services, and children's and family programs. IF currently has 13+ facilities with 22+ micro-communities scattered across Orange County, Los Angeles County, and the Inland Empire.

Job Description

The Medical Coordination Assistant is responsible for assisting the providers in providing care to their patients. Their duties include performing basic technical, administrative, and clerical support services. The pay range for this position is $21.50 - $4.00 per hour, depending on experience. This position also qualifies for a 1.50 swing shift differential and a 3 graveyard shift differential. The hours for this position are 3:00 pm - 11:30 pm, Thursday - Monday.

Responsibilities

• Perform initial intakes to ensure proper client discharge from the hospital with all appropriate needs for the continuation of care and document all findings.
• Assess the medical and mental health status of clients upon arrival by conducting head-to-toe assessments, checking vitals, determining insurance status, making follow-up appointments with clients' doctors, and picking up/filling prescriptions as needed.
• Conduct morning, afternoon, and evening checks for all assigned clients to observe wellbeing, ensuring there is no change in medical conditions since hospital discharge.
• Link clients to medical services when necessary (insurance, PCP, specialists, referrals)
• Coordinate home health visits (if needed) and follow-up MD appointments.
• Promote health literacy by providing patient education about clients' illnesses, medications, preventative measures, treatment management, and overall general health with the supervision of the Medical Coordinator.
• Exit clients by providing clients with an exit report that includes a list of current medications, future MD appointments, insurance information, and other applicable medical information.
• Arrange transportation for clients to and from medical appointments if needed to advocate for client needs.
• Report emergencies to the Supervisor/Manager and document incident
  • Seek a proper level of care to assess and treat a medical complication
  • Initiate medical response system when appropriate
• Support client recuperation by providing necessary items and space needed to rehabilitate and assisting with the upkeep of the facility.

Administrative/Record Keeping

• Enter client information and case notes into KIPU and other documentation systems.
• Complete and update medication, vitals, and/or diabetic logs.
• Perform administrative tasks such as answering phones and filing paperwork.
• Maintain proper inventory of medical supplies and medications.

Compliance/Safety

• Maintain confidentiality by HIPAA guidelines and DHS standards.
• Provide clients with proper compliance forms upon admission to maintain client compliance with program rules.
• Provide care utilizing infection control measures that protect both the staff and the client according to OSHA standards.
• Conduct medication reconciliation and ensure proper disposal and pickup of bio-medical/pharmaceutical waste.
• Maintain a safe work environment by ensuring the cleanliness of the med room, wound care room, and med storage room.
• Ensure medical equipment remains in operating condition.

Preferred Experience/Minimum Qualifications Required

• Associate's degree in a medical field or a Valid California Certifying Board for Medical Assistants certificate
• 2+ years of working in the healthcare field
• Strong verbal and written skills
• Superior customer service skills
• High level of professionalism

Preferred

• Bilingual in English and Spanish
• Certification (CMA, RMA, CCMA, EMT)

Benefits

• Medical insurance funded up to 91% by Illumination Foundation (Kaiser and Blue Shield), depending on the plan
• Dental and vision insurance
• Life, AD&D, and LTD insurance funded 100% by Illumination Foundation
• Employee assistance program
• Professional development reimbursement
• 401K with company matching
• 10 days vacation PTO/year
• 6 days sick PTO/year
• 10 days holiday PTO/year
• Potential eligibility for the Public Service Loan Forgiveness Program (PSFL) for federally qualified loans