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Medical Case Manager, RN Unit Manager

Employer
AmTrust Financial Services
Location
Maitland, Florida
Salary
Not Specified
Closing date
Dec 4, 2019

View more

Category
Claims
Job Type
Not Specified
Career Level
Not Specified

Job Details

Overview

AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN Unit Manager.

The Medical Case Management Nurse Unit Manager will oversee operations as well as a team of experienced Workers Compensation Nurse Case Managers in our Maitland, FL or Alpharetta, GA office. The ideal candidate will have 3+ years' experience overseeing a nursing claims management program, as well as an in-depth understanding of workers' comp injury claims and Utilization Management/Review.
PRIMARY PURPOSE: The telephonic medical case manager will provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination. The telephonic medical case manager unit manager is responsible for product quality and the daily performance of the telephonic case management nurse staff.

Responsibilities

• Holds responsibility for all case management production and assures the company of appropriate quantity and quality
• Assist in the identification, hiring, and training of qualified medical case management staff
• Set production and quality goals for medical case management staff. Regularly monitor results and communicate them to the team members.
• Establish Performance Improvement Programs for underperforming staff
• Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered.
• Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
• Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary
• Responsible for accurate comprehensive documentation of case management activities in case management system.
• Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
• Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment.
• Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
• Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.
• Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
• Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
• Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
• Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
• Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
• Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
• Other duties may be assigned.
• Supports the organization's quality program(s).

Qualifications

Education & Licensing
Active unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Acquisition and maintenance of Insurance License(s) may be required to comply with state requirements. Preferred for license(s) to be obtained within three - six months of starting the job.
Experience
Minimum of two (2) years of successful clinical supervision experience
Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required.

Skills & Knowledge:
Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
Knowledge of behavioral health
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytic and interpretive skills
Strong organizational skills
Excellent interpersonal and negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Work Environment:
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking

What We Offer:

AmTrust Financial Services offers a great work environment, competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical and Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, and Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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Company

AmTrust Financial Services, Inc. was founded in 1998 to provide property and casualty insurance to small businesses. Through acquisitions and organic growth, AmTrust Financial Services has since grown to become a multinational property and casualty insurer specializing in coverage for small to mid-sized businesses. Our financial stability is based upon a philosophy of niche diversity with a focus on low-hazard risk.

Since its inception, AmTrust has crafted a balanced portfolio of insurance products including:

  • Multiline Small Business Insurance
  • Warranty and Specialty Risk Insurance
  • Specialty Program Business Insurance

In November 2006, the company became publicly traded on the NASDAQ Global Market under the symbol AFSI. With extensive underwriting experience and a prestigious "A" (Excellent) Financial Size "XI" rating from A.M. Best, AmTrust has earned a reputation as an innovative, technology driven provider of insurance products. Our commitment to excellence is the common thread connecting each of our businesses.

Company info
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