Human Resources Assistant
Jafferjee Brothers Exports (Pvt) Ltd
Job type full-time
Full job description
Nurse case manager ii
Virtual req #13947
Thursday, april 29, 2021
For more than 160 years, the hanover has been committed to delivering on our promises and being there when it matters the mostWe live our values every day, demonstrating we care.
Our claims team is currently seeking a nurse case manager iiThis is a full time/exempt
Position overview: responsible to provide professional nurse case management coordination for claimants with compensable injuriesParticipate collaboratively with various members of claims team, treatment providers, employers and network vendors.
Monitors and evaluates claimants' responses to medical treatment and progress in recovery, and makes recommendations for alternative treatment or care options if needed
Collaborates with treatment providers and claimant for cost effective medical treatment
Assists with removing roadblocks to treatment adherence by the claimant or insured party
Collaborates with claim handler for utilization review services as appropriate
Coordinates and monitors clinical treatment services such as discharge planning, medical specialty referrals, and vendor needsThis may include inpatient and outpatient services, mds, home care, attendant care, and/or network partners for ancillary services
Evaluates the components of the injured/ill claimant's job with claimant and employer and, if appropriate, clarifies the critical demands of the job and suggests any necessary modifications or accommodations to comply with government regulations (in wc/pip claims) with a focus on ability and return to work
Educates and evaluates injured/ill claimant/class member, insured party, and health care provider regarding patient's response to treatment to enhance claimant adherence and progress toward maximum medical improvement as well as return to work planning
Coordinates and arranges for cost effective service delivery that is consistent with the claimant's health care requirements and policy benefits
Coordinates and monitors referrals to rehabilitation and medical case management vendors
Reviews and recommends need for an independent medical exam, including area of medical specialty
Assists in projection of medical reserves for the life of the claim
Collaborates with pip/wc teams for roundtables
Maintain accurate and timely metrics including billing
Participate and prepare educational presentations to nursing peers and claims department staff as needed
Reports electronic data for utilization of ncm resources and claimant progress and outcomes with hig guidelines and software programs.
Registered nurse with current state licensure
Ability and commitment to obtain ccm certification
Minimum of three years of clinical experience in applicable nursing specialty field (i.eOccupational health, rehabilitation, orthopedics, home care, emergency, etc.)
Working knowledge of utilization review process, medical bill review and/or medical case management
Ability to collaborate and work effectively in a team environment
Strong analytical, problem solving and negotiation skills
Effective interpersonal communication and writing skills
Organization skills with regard to time management, task prioritization, and integration of information from a variety of sources
Ability to determine and meet internal and external customer needs
Word processing skills
Current driver's license (field position)
Fluent in english
Knowledge of technical materials, rules, procedures or facts required to effectively performing the role such as : utilization criteria), medical coding mechanisms( icd-9 cm, cpt-4, dsm-iv), case management standards of practice, state workers' compensation and personal injury protection (pip) regulations
Ability to adapt to a dynamic work environment
Pc/ keyboard skills.
This job posting provides cursory examples of some of the job duties associated with this positionThe examples provided are not complete, and the position may entail other essential and job-related functions and responsibilities that employees will be required to perform.
Career development: it’s not just a job, it’s a career, and we are here to support you every step of the wayWe want you to be successful and fulfilledThrough on-the-job experiences, personalized coaching and our robust learning and development programs, we encourage you – at every level – to grow and develop.
Benefits: we offer comprehensive benefits to help you be healthy, build financial security, and balance work and home lifeAt the hanover, you’ll enjoy what you do and have the support you need to succeedBenefits include:
Medical, dental, vision, life, and disability insurance
401k with a company match
9 company holidays
Flexible work arrangements
On-site medical/wellness center (worcester only)
“the hanover values diversity in the workplace and among our customersThe company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry or any other status protected by law.
Furthermore, the hanover insurance group is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information or any other status protected by law.”
As an equal opportunity employer, hanover does not discriminate against qualified individuals with disabilitiesIf you require a reasonable accommodation, as a candidate for employment, please inform the hanover talent acquisition office.
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