Nationwide Telephonic Nurse Case Manager in Des Moines, Iowa

#claims

Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247 or click here.

This position supports Nationwide Agribusiness. The ideal candidate will have a CCM or have the willingness to take the exam within the first year of employment.

JOB SUMMARY: 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. Responsible for helping to ensure injured workers receive appropriate treatment directly related to the compensable injury and for assisting claim handlers in managing medical treatment to an appropriate resolution. Acts as a liaison with injured employee/family, employer, provider(s), insurance company, and healthcare personnel.

REPORTING RELATIONSHIPS: Reports to Manager or Director. No direct reports, but may lead others on projects and assignments

CORE JOB DUTIES & RESPONSIBILITIES:

  • Works telephonically with workers' compensation patients, employers, providers, and claim handlers to coordinate and assure proper delivery and oversight of medical and disability services.

  • Authorizes medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.

  • Evaluates and coordinates quality, cost effective medical and rehabilitative services.

  • Proactively manages the medical expenses by partnering with specialty resources (i.e. diagnostic and other ancillary services vendors) to achieve appropriate claim outcomes.

  • Plans a proactive course of action to address issues presented to enhance the injured employee's short and long-term outcomes.

  • Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care.

  • Assists the injured worker by providing medical and disability education and coordinating on-site job analysis; work conditioning; functional capacities; and ergonomic evaluations.

  • Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work.

  • Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches; over or under utilization; inappropriate care; effective treatment; permanent or temporary loss of function; failed or premature return to work; and non-compliance.

  • Adheres to all appropriate privacy, security and confidentiality policies and procedures. Complies with established Best Practices.

  • Performs other duties as assigned.

MINIMUM JOB REQUIREMENTS:

Education: Bachelor’s Degree required

License/Certification/Designation: Registered Nurse with current state license(s) required. CDMS, CRC, CCM, or CRRN designation desirable.

Experience: 3 or more years) clinical experience required, preferably in emergency room, orthopedics, neurological, critical care, and/or physical rehabilitation setting. Previous Workers’ compensation or disability case management experience preferred.

Knowledge: Knowledge of medical causation and relatedness as well as medical diagnostics, procedures and treatment standards is necessary. Understanding of Workers’ Compensation laws preferred.

Skills/Competencies: Excellent written and verbal communication, organizational and interpersonal, customer service, time management, and problem solving skills required. Proficiency in Microsoft Office products, such as Word and Excel, as well as experience with internet searches and a comfort level with other software programs required. Ability to set priorities and work independently is essential.

Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.

Staffing Exceptions to the above Minimum Job Requirements must be approved by the: hiring manager’s leader and HRBP.

JOB CONDITIONS:

Overtime Eligibility: Not Eligible (Exempt)

Working Conditions: Normal office environment. Occasional travel may be required.

ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.

Job Family/Function: CLM/WCC

Job Evaluation Activity: 03/2014 AJL

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