The role will work full time in the Charleston, WV office and report to a Director, Workers' Compensation Claims on the WV Large accounts team.
The Nurse Case Manager serves as an office-based skilled medical resource for the business teams. The position’s objective is to provide high quality customer service in medical case management and utilization review, primarily telephonically. The Nurse Case Manager provides medical expertise and serves a critical role in the cost containment of medical and indemnity expenses.
ESSENTIAL FUNCTIONS: [complete listing on Encova.com]
Complete early medical management assessment and intervention on claims requiring medical treatment.
Contact injured workers and medical providers to obtain necessary information.
Apply knowledge, experience and evidence-based guidelines to evaluate claims and provide a proactive action plan.
Perform essential medical case management activities assessment, planning, implementation, monitoring and evaluation within accepted treatment guidelines.
Address medical cost containment through utilization management, collaboration with providers and assessing network resources.
Partner with appropriate team members to expedite injured worker recovery and return to work and to reduce disability costs.
Identify and monitor claims for task assignments to field case managers.
OTHER FUNCTIONS: [complete listing on encova.com]
Ability to collect relevant information, establish facts, and draw relevant conclusions, and recommend effective solutions.
Working knowledge of evidence-based treatment guidelines, treatment protocols, medical causation and relatedness.
Ability to efficiently coordinate effective medical treatment while maximizing cost containment.
Understanding of workers’ compensation laws, rules and regulations.
Ability to define problems related to workers’ compensation claims and related processes.
Ability to effectively collaborate with multiple team members and stakeholders.
KNOWLEDGE, SKILLS AND ABILITIES:
Licensed Registered Nurse with no restrictions, through one or more of the following:
Master’s degree from an accredited college or university in Nursing; plus one year of experience in nurse case management, or medical case management, or utilization review, or vocational/disability case management are required;
Bachelor’s degree from an accredited college or university in nursing; plus minimum of three years’ experience in nurse case management, or medical case management, or utilization review, or vocational/disability case management are required; OR
Associate degree in nursing from an accredited college or university or successful completion of a diploma nursing program; plus four years’ experience in nurse case management, or medical case management, or utilization review, or vocational/disability case management are required.
Must meet jurisdictional requirement(s) for workers’ compensation medical case management designation(s).
Nationally recognized specialty certification in occupational or rehabilitative nursing or case management must be obtained as applicable, such as Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Registered Rehabilitation Nurse (CRRN), or Certified Occupational Health Nurse (COHN).
Two or more years of clinical experience in orthopedics, neurology, rehabilitation, internal medicine, or occupational medicine is preferred.
Multi-state case management experience is desired.
Bilingual ability is a plus.
Additional Salary Information: Competitive salaries and comprehensive benefits
Internal Number: 100
About Encova Insurance
Encova Insurance provides commercial, auto, home and life insurance. A super-regional carrier ranked in the top 20 mutual insurance companies in the United States, Encova includes more than 1,200 associates writing in 28 states and the District of Columbia, premiums in excess of $1 billion, a surplus in excess of $1.6 billion and assets in excess of $4.1 billion. The group markets insurance solutions through more than 2,000 independent agencies in the Midwest, Northeast and South.
Encova stands on the quality and training of our people. Associates' initiative, ideas, problem-solving skills and abilities contribute to our growth and success. We recognize individual performance with a progressive salary program and a generous benefits package.
We value the diversity of our associates because our people are the source of our success. We know that none of us is as smart as all of us, and through diversity of thought and background comes innovative solutions. By offering flexible benefits that can be tailored to meet individual needs, our goal is to provide our associates with the health care, resources, time off, professional development and financial incentives they need to be s...uccessful.
Benefits are offered to all full-time or part-time associates who are regularly scheduled to work at least 20 hours per week. Benefits include but are not limited to:
A comprehensive health care plan, including preventative services covered at 100%
Dental and vision benefits