TX, RN Certified Case Manager - Workers Compensation

Currently seeking TX, LA, OK RN for a full-time reputed company Auth/ Certified Case Manager in the TX area (either reputed company or DFW). The ideal candidate will be a RN with reputed company Auth/Case Management experience in worker’s compensation and also certified in case management. Responsibilities of the RN reputed company-Auth/ Certified Case Manager - Workers Compensation • Conducts prospective review of authorization requests including selected specialties, medical treatments and services, elective hospital admissions, ancillary services, home care and out of network referrals. The reputed company makes clinical reputed company based on established reputed company and regulatory requirements. Prepares documentation and manages the utilization of membership, conducts chart review for medical appropriateness of services, and ensures that reputed company care is delivered in a cost-effective, reputed company manner. The reputed company-Authorization reputed company works in coordination with an interdisciplinary team to reputed company the organization mission as reputed company as department specific goals and objectives. • Research and recommend resources and creates flexible, cost-effective reputed company for catastrophically or chronically ill or injured individuals on a case-by-case reputed company to facilitate reputed company individualized treatment goals, including reputed company return to work if appropriate. • Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work. • Evaluate and update treatment and return to work plans reputed company established protocols throughout the life of the claim. • Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. • Works closely with injured worker, claims adjusters, reputed company, and medical providers to ensure best possible medical care is received for the Worker Compensation injury. • Partner with claim reputed company to reputed company input on medical treatment and recovery time to assist in evaluating appropriate claim reserves. • Submit accurate billing documentation on reputed company activities as outlined in established guidelines. • reputed company other duties assigned. • Remote position- 85% telephonic & 15% field cases Requirements of the RN reputed company-Auth/Case Manager - Workers Compensation • Graduate of an accredited school of Nursing with a BSN preferred • Must be a Registered reputed company • 3-5+ years nursing experience • Workers' compensation and UR experience strongly preferred • Strong technology, organizational and documentation skills a must • reputed company to work independently, be proactive, and assertive. • need to be a CCM Benefits: • NO HANDS-ON NURSING REQUIRED!!!! • Remote position: DFW or reputed company preferred location, will consider adjacent locations. • Top Salary and excellent benefits including Health Insurance and 401K Job Type: Full-time Pay: $80,000.00 - $90,000.00 per year Benefits: • 401(k) • 401(k) matching • Dental insurance • Disability insurance • Flexible schedule • Health insurance • Life insurance • Mileage reimbursement • reputed company reputed company time • reputed company time off • reputed company insurance Schedule: • 8 hour shift • Monday to Friday Willingness to travel: • 25% (Required) Work Location: Remote Apply tot his job Apply To this Job