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Posted: Saturday, March 4, 2017 5:37 AM

Nurse Case Manager (CCM)
Job ID : 8548 Location: Roseville, CA
Functional Area: Claims SBU:
Position Type: Full : Time
Education Required: Technical Degree
Experience Required: 3 : 5 Years
Relocation Provided:
Job Description
Where Great People Build Successful Careers.
The Hanover is seeking a Certified Nurse Case Manager to join our growing team in our Roseville, CA office.
Position Summary:
The Nurse Case Manager is responsible to provide case management coordination for claimants with compensable injuries. Participate collaboratively with various members of claims team, treatment providers and network vendors.
Responsibilities/Essential Functions:
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Negotiates fees with vocational rehabilitation, medical case management and DME vendors.
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Coordinates and monitors referrals to rehabilitation and medical case management vendors.
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Coordinates services as indicated with HIG Utilization Review department nursing staff.
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Gathers, compiles, analyzes and reports service data significant to clients
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Acts as resource to claims professionals, underwriting and account representatives for identification of appropriate medical services, goods and providers
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Coordinates MDL requirements for ongoing certification
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Reviews and determines need for an Independent Medical Exam, including area of medical specialty
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Assists in projection of reserves for the life of the claim and collaborates with adjuster for roundtables.
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Assesses healthcare needs associated with compensable/covered illness/injury claims and comorbidities.
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Coordinates and arranges for cost effective service delivery that is consistent with the claimants health care requirements and policy benefits
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Educates and evaluates injured/ill claimant/class member, insured party, and health care provider regarding patients response to treatment to enhance claimant adherence and progress toward maximum medical improvement as well as Return to Work planning.
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Monitors and evaluates claimants responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed.
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Collaborates with treatment providers and claimant for cost effective medical treatment.
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Assists with removing roadblocks to treatment adherence by the claimant or insured party.
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Coordinates and monitors clinical treatment services such as discharge planning, medical specialty referrals, and vendor needs. This may include inpatient and outpatient services MDs home care, attendant care, and/or network partners for ancillary services.
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Evaluates the components of the injured/ill claimants job with claimant and employer and, if appropriate, clarifies the critical demands of the job and suggests any necessary modifications or accommodations to comply with government regulations (in WC/PIP claims) with a focus on ability and return to work.
: Reports electronic data for utilization of NCM resources and claimant progress and outcomes with HIG guidelines and software programs.
: May assist/direct clients in applying for social security disability
: Participate and prepare educational presentations to nursing peers and claims department staff as needed.
Position Requirements
Requirements:
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Registered nurse with current state licensure. Obtain other state licenses if necessary.
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Certified Case Manager certification
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Minimum of three years of clinical experience in applicable nursing specialty field (i.e. occupational health, rehabilitation, orthopedics, home care, emergency, etc.)
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Working knowledge of utilization review process, medical bill review and/or medical case management
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Ability to collaborate and work effectively in a team environment
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Strong analytical, problem solving and negotiation skills
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Effective interpersonal communication and writing skills
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Or

Source: https://www.tiptopjob.com/jobs/63565165_job.asp?source=backpage


• Location: Roseville, Sacramento

• Post ID: 13617791 sacramento
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