Medical & Disability Nurse Case Manager at internal in US-TX-Plano

Job description

• If you're a registered nurse looking for a new opportunity to work in a fast-paced, professional environment where your talent contributes to our competitive edge, Liberty Mutual Insurance has the opportunity for you. Under general technical direction, responsible for medically managing assigned caseload and by applying clinical expertise ensure individuals receive appropriate healthcare in order to return to work and normal activity in a timely and cost effective manner. Caseload may include catastrophic/complex medical/disability cases, lost time, and/or medical only claims. Also act as a clinical resource for field claim partners.
• Candidates residing in Central and West Coast time zones are encouraged to apply, as this role primarily partners with teams and stakeholders in those regions. Candidates must have a stable and reliable high-speed internet connection capable of supporting business applications, virtual meetings, and voice communications with minimal disruptions.
• Candidates who reside within 50 miles of the Lake Oswego, OR, Plano, TX, or Chandler, AZ office locations will be expected to commute to the office in accordance with Liberty Mutual's hybrid work guidelines and business needs.

Responsibilities

• Follows Liberty Mutual's established standards and protocols to effectively manage assigned caseload of medical/disability cases and by applying clinical expertise assist to achieve optimal outcome and to facilitate claim resolution and disposition.
• Effectively communicates with injured employees, medical professionals, field claims staff, attorneys, and others to obtain information, and to negotiate medical treatment and return to work plans using critical thinking skills, clinical expertise and other resources as needed to achieve an optimal case outcome.
• Utilizes the Nursing Process (assessment, diagnosis, planning, intervention and evaluation) to facilitate medical management to attain maximum medical improvement and return-to-work (RTW) per state jurisdictional requirements.
• Appropriately utilizes internal and external resources and referrals i.e., Utilization Review, Peer Review, Field Claims Specialists, Regional Medical Director Consults, and Vocational Rehabilitation to achieve best possible case outcome.
• Follows general technical direction from nurse manager, senior medical and disability case manager and/or CCMU staff to resolve highly complex medical and/or RTW issues and/or successfully manage catastrophic injuries.
• Documents all RN activities accurately, concisely and on a timely basis. This includes documenting the medical and disability case management strategies for claim resolution, based on clinical expertise. Adheres to confidentiality policy.
• Appropriately applies clinical expertise to claims and delivers services in an efficient and effective manner.
• Accurately and appropriately documents time tracking for work performed. Achieves annual time tracking goal.
• Handles special projects as assigned.

Requirements

• Ability to analyze and make sound nursing judgments and to accurately document activities.
• Strong communication skills in order to build relationships with injured employees, medical professionals, employers, field claims staff and others.
• Good negotiation skills to effectively establish target return to work dates and coordinate medical care.
• Knowledge of state, local and federal laws related to health care delivery preferred.
• Personal computer knowledge and proficiency in general computer applications such as Internet Explorer and Microsoft Office (including Word, Excel and Outlook).
• Degree from an accredited nursing school required (prefer Bachelor of Science in Nursing).
• Minimum of 3 to 5 years of clinical nursing experience; prefer previous orthopedic, emergency room, critical care, home care or rehab care experience.
• Previous medical case management experience a plus.
• Must also have current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
• Must have additional professional certifications, such as CCM, COHN, CRRN, etc., where required by WC law.
• Employees may apply for a new role after completing 12 months of employment in their current position.
• Employees should review all role requirements and apply only for positions for which they are eligible. Hiring processes may vary by country, including differences in procedures, requirements, and timelines. For country-specific details, please consult your local recruiting / HR team.

Skills

Required

• Strong communication skills
• Good negotiation skills