Telephonic Nurse Case Manager
In this role you will work on our Absentia fee-for-service team. You are responsible for completion of the ID15 process, medical case management of open high-risk cases and integration of the RTW Solution with our customers.
1. Complete ID15 on potentially high-risk claims.
2. Conduct ID15 online interviews with employer, injured worker and medical provider, following State Auto standards for appropriate classification of high risk claims.
3. Provide rigorous attempts to reach employer, injured worker and medical provider including sending correspondence if injured worker cannot be reached after several attempts.
4. Appropriately document all correspondence, contacts and actions on a claim per State Auto standards.
5. Complete Risk Assessment and Obstacle and Strategy report to appropriate parties by-product.
6. In partnership with the sales and/or account management teams and/or claims team members, participate in the development, implementation and ongoing refinement of workers’ compensation and/or disability, return to work program for our customers.
7. Establish a workers’ compensation and/or disability management program with customer including identification and coordination with medical providers, internal/external claims administrators and/or other external service providers.
8. Coach customers to refine and improve their workers’ compensation/disability management program in areas of injury report filing and in coordination with loss prevention, supporting provision of transitional duty by assisting customers in identifying industry specific light duty options as needed.
9. Actively participate in strategy sessions, client check in meetings and/or dispute resolution meetings as requested.
10. Build a working relationship with all ID15 high risk injured workers, customers and medical providers.
11. Obtain treatment plan and facilitate injured worker’s return to work and adherence to their treatment plan.
12. Provide customers with a plan of action, regular communication, support on injured worker’s treatment plan, early return-to-work as soon as medically feasible and ongoing return-to-work progress.
13. Strategize with other associates (internal and external) to appropriately move the case towards resolution.
Minimum Experience / Education:
Registered Nurse licensure required. Workers’ compensation and/or disability case management experience required. Certified Case Manager(CCM) and/or COHN preferred. Bi-lingual in Spanish a plus.
Communication and Collaboration Skills:
Abilities: flexibility, customer focus, creativity and innovation, continuous learning. Maintain reasonable and predictable work attendance. Skilled in: personal leadership, relationship building, problem-solving, planning and organization, conflict resolution, accountability, persuading and influencing.
Knowledge of: medical diagnostics, procedures and treatment standards, occupational health and basic recovery theory, State Auto customer integration and management process, Account Management roles and responsibilities, claims roles and responsibilities, basic workers’ compensation and disability laws and rules. Skilled in: written and verbal communication, presentations, computer proficiency, customer service, problem-solving, articulating workers’ compensation/disability benefits. Ability to: read and interpret medical records, articulate and enroll others into State Auto vision, philosophy, program components and requirements, and effectively coach and mentor associates. Maintain reasonable and predictable work attendance.
More about us:
State Auto offers a competitive salary, an annual bonus program, an excellent benefits program including medical, dental, vision and prescription insurance coverage, life insurance, matching 401(k) plan, flexible spending accounts, tuition assistance, and a stock purchase plan.
State Auto is committed to the principle of equal employment opportunity for all associates and applicants and to providing associates with a work environment that is free from discrimination and harassment. All employment decisions (hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, training and work assignments) are based on business needs, job requirements and individual qualifications without regard to race, color, religion, gender, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, citizenship status, military status, or status as a covered veteran in accordance with applicable federal, state and local laws. State Auto will not tolerate discrimination or harassment based on any of these characteristics.
State Auto is a smoke-free work environment. We utilize drug screening and background checks as conditions of employment. For all exempt positions, we also obtain motor vehicle reports (MVR s).
State Auto will not accept candidates from third-party recruiters without a signed agreement with State Auto.