Nurse Case Manager

The nurse case manager serves as a skilled medical case management resource for the business teams.  The position’s objective is to provide high quality customer service in disability case management.  The nurse case manager provides medical expertise and serves as the critical communication link between all parties involved in the medical disability case.

The items listed are essential functions of the position unless otherwise stated. Position Responsibilities: (complete listing on company website at brickstreet.com) 

Assists the business group leader and teams by keeping apprised of emerging trends in the medical community as they relate to workers’ compensation claims.

Provides documentation, feedback, and reports to business group leaders and teams with emphasis on returning medically able individuals to productive endeavor.

Performs claims analysis and identifies trend factors on known high value incidents and as requested.

Skill Requirements:  (Complete listing on company website at brickstreet.com)  

• Ability to correctly define problems related to workers’ compensation claims and related processes, collect relevant data, establish facts and draw valid conclusions, as well as recommend effective solutions.
• Ability to properly apply medical terminology, anatomy and body systems terms, disease and diagnosis codes, as well as treatment protocols, in the review of claims decisions.
• Working knowledge of the theory, principles, and practices of medical case management.
• Extensive knowledge of medical terminology, medical codes and medications.
• Ability to maintain knowledge of current trends and developments in the medical case management field.

  
   RequirementsEducation and Experience: 

• Bachelor’s degree in nursing from an accredited 4-year college or university required. 

 

• An Associate’s Degree in nursing from an accredited college or university may be considered.
• Alternately, a diploma nursing program plus four years of experience in nurse case management, medical case management, vocational case management, and/or disability case management may be considered.
• Two years of full-time experience or equivalent part-time paid experience as a registered professional nurse in nurse case management, medical case management, vocational case management, and/or disability case management.
• Licensed Registered Professional Nurse required.
• Nationally recognized specialty certification in case management must be obtained within 18 months of hire date.
• Industry certification (CCM, CRRN, CVE, CRC, CDMSC, or CRCN) is desired.
• Professional insurance designations relevant to area of expertise desired.
• West Virginia Qualified Rehabilitation Professional (WVQRP) eligibility is preferred.
• Preference may be shown to those with experience in Virginia and Pennsylvania.

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Country: USA, State: West Virginia, City: Charleston, Company: BrickStreet Mutual Insurance Company.