RN Case Manager - Workers' Compensation

A Workers' Compensation Nurse Case Manager coordinates and manages the medical care of injured employees throughout the workers' compensation claim process.

Responsibilities include evaluating medical needs, assessing treatment progress, identifying barriers to recovery, educating stakeholders, and ensuring care is delivered in accordance with workers' compensation regulations and best practices. The official NJM job title is Medical Management Coordinator II/Telephonic Nurse Case Manager.

The position requires the nurse to work and communicate with other members of the Medical Management team in addition to the Workers' Compensation (WC) Claims team, WC Claims Supervisors, and other team members.

Essential Duties and Responsibilities:

• Demonstrate knowledge, skills, and competency in the application of case management standards of practice.
• Develop and provide ongoing support of the rehabilitation plan through comprehensive assessment, planning, implementation, and overall evaluation of individual claimant needs.
• Facilitate the Injured Worker’s rehabilitation by coordinating medical treatment, advocate for the Injured Worker with all medical providers and stakeholders and educate the Injured Worker on their recovery process.
• Understand, apply, and comply with all statutory, regulatory, licensing requirements, and NJM policies/guidelines that affect utilization review, case management, and medical management.
• Attend on-site visits with Injured Worker, physicians and other treatment providers, when necessary.
• Evaluate the appropriateness, medical need and efficiency of health care procedures and facilities according to established criteria or guidelines.
• Effectively communicate and collaborate with management, peers, and colleagues to ensure alignment, compliance and effective management of assigned claims.
• Participate and/or support identified project initiatives
• Proactively seek development opportunities and identify business process improvements to maximize effectiveness of operations and minimize cost.

Required Qualifications:

• RN required
• 5 years of clinical nursing experience required
• WC/PIP experience preferred
• Ability to travel within State of NJ/assigned territory dependent on business needs.
• Bachelor of Science in Nursing (BSN) is preferred.
• Certified Case Manager (CCM) beneficial.
• Strong internal and external relationship management skills
• Detail oriented with exceptional time management and organizational skills.
• Ability to work independently and in a team environment
• Proactive
• Willingness to learn and grow within the position
• Demonstrate reliability and conform to the company’s attendance policy
• Intermediate Microsoft Office Suite skills (Outlook, Word, Excel, PowerPoint) with ability to navigate technology and multiple systems effortlessly.
• High School Diploma or GED Equivalent

Compensation: Salary is commensurate with experience and credentials.

Pay Range: $84,610-$98,261