Clinic Nurse Medical Case Manager - Workers Compensation

Clinic Nurse Medical Case Manager role for Travelers Workers Compensation claims, with a hybrid mix of office work and work at a Concentra clinic. The role focuses on early intervention, return to work planning, coordinating quality medical care, and supporting claim resolution through medical reviews and specialty resources.

• Meet injured employees face to face following office visits at provider medical facilities to assist the claim process and ensure compliance with medical treatment plans
• Contact customer, medical provider and injured parties to coordinate appropriate medical care and return to work
• Develop strategies to facilitate return to work and achieve maximum medical improvement; evaluate and update treatment and return to work plans within established protocols
• Coordinate with medical providers to ensure injured employee participation in a viable treatment plan
• Evaluate medical treatment requests for reasonableness and necessity based on jurisdictional guidelines

Case management in a claims environment using structured workflows for treatment and return to work plans. Involves evaluating medical treatment requests using jurisdictional guidelines and coordinating disability status and provider participation.

The ideal candidate is a nurse experienced in medical case management for Workers Compensation claims, with a strong focus on early intervention and return to work planning. They can coordinate telephonic and in-person provider activities, evaluate treatment requests against jurisdictional guidelines, and support injured parties to achieve maximum medical improvement.