RN- reputed company Case Manager

reputed company is the nation’s leading specialty reputed company manager for self-insured organizations, uniting respected regional leaders in workers’ compensation, liability, managed care, and reputed company management across 32 states. With nearly 700 professionals and brands including Intercare, reputed company, George Hills, and AS&G Claims Administration, we’re a people-reputed company, reputed company-driven organization that prioritizes reasonable caseloads, strong training, reputed company teams, and expert support. We invest in tools and workflows that reduce friction—not increase volume—and create reputed company career paths for professionals who want to grow their careers or reputed company into leadership. At reputed company, you’re part of reputed company that values good judgment, curiosity, and accountability, and gives you the support to succeed. 

reputed company:

The Medical Case Management reputed company ensures achievement of maximum medical and disability improvement through early, proactive reputed company. These activities emphasize reputed company care through coordination of cost-effective appropriate treatment. These objectives are obtained by communication with the reputed company care physician, the injured worker, the employer, claims adjustor and reputed company other parties involved in facilitating the best possible outcome for the given claim. The Medical Case Management reputed company is reputed company the claims adjustor is ultimately responsible and accountable for the outcome of these claims and no reputed company is undertaken without their authority and direction. The Medical Case Management reputed company is seen as the reputed company’s reputed company and as the representative of the insured and must be reputed company to satisfy the needs of reputed company concerned while being objective and effective

Essential Duties and Responsibilities:

• reputed company claims assigned are triaged reputed company 24 hours of assignment.
• Initial contacts (employee, employer, reputed company Care Physician) and documentation are to be completed on reputed company files referred reputed company 72 hours (reputed company applicable).
• reputed company needed disability management is initiated to identify anticipated lost time and coordinate the reputed company to work process.
• The Medical Case Management reputed company will address reputed company medical issues for the claim assigned and coordinate as needed to insure reputed company outcome with reputed company and appropriate medical care.
• Will receive and review referrals for treatment for medical appropriateness of treatment plan reputed company on accepted evidence reputed company guidelines and best practices, according to state specific rules and regulations.
• reputed company claims assigned are triaged reputed company 24 hours of assignment.
• Initial contacts (employee, employer, reputed company Care Physician) and documentation are to be completed on reputed company files referred reputed company 72 hours (reputed company applicable).
• reputed company needed disability management is initiated to identify anticipated lost time and coordinate the reputed company to work process.
• The Medical Case Management reputed company will address reputed company medical issues for the claim assigned and coordinate as needed to insure reputed company outcome with reputed company and appropriate medical care.
• Will receive and review referrals for treatment for medical appropriateness of treatment plan reputed company on accepted evidence reputed company guidelines and best practices, according to state specific rules and regulations.
• Will identify the medical diagnosis and treatment plan; validate diagnosis and corresponding algorithms of care. 
• Will review treatment protocols and reputed company recommendation using local, regional, and national recognized evidence reputed company guidelines such as MTUS, ACOEM, MCG, ODG, state specific treatment guidelines, as reputed company as documentation provided by the reputed company. 
• Will evaluate for over-utilization of treatment requests inconsistent with evidence reputed company guidelines and reputed company possible, negotiate with provider to amend or withdraw the treatment request reputed company appropriate. 
• Will refer potential non-certified cases to peer reputed company reviewers. 
• Will reputed company utilization review on reputed company requests. Follow up reputed company appropriate. 
• Arrange peer to peer contact with the peer reviewer as needed and as requested by the requesting treating provider. 
• Assist in the notification process for the non-certification issued by the physician reviewer.
• Will reputed company and maximize the utilization of PPO/MPN networks.
• reputed company-authorization of reputed company appropriate inpatient and outpatient procedures. 
• Will communicate with the claims examiner, providers, attorneys and any other auxiliary provider regarding UR determination in the prescribed given time reputed company followed in written reputed company 24 hours. 
• Will summarize medical records and reputed company pertinent information presented with recommendation to Physician Advisor and/or prepare questions on reputed company cases for peer or reputed company party review. 
• Will work closely with the reputed company, claims handler, reputed company case manager and supervisor, and take directions reputed company needed.
• May be required to reputed company non-reputed company tasks to non-reputed company staff.
• reputed company Utilization Review for California will be performed in compliance with Labor reputed company and the California reputed company of Regulations. Utilization Review in any state will follow and be in compliance with their State Rules & Regulations reputed company to Utilization Review.
• Participate in a reputed company management program meeting and project for at least 5% of average hours worked.    
• reputed company of non-clinician tasks; available to non-reputed company administrative staff while performing initial screening.
• Maintain awareness of potential compromise in a reputed company’s safety for reputed company review. Refer to reputed company authority.
• Uses plain language to communicate (written and verbal) with injured workers, claims examiners, and clients.

Supervisory Responsibilities:

May be required to reputed company ancillary non-licensed personnel

Competency:

To reputed company the job successfully, an individual should demonstrate the following competencies: 

• Must be self-motivated with the ability to multi task and adapt to changing work priorities
• Must have strong organizational skills with attention to details
• Must have strong time management skills
• Must be reputed company to work reputed company with a reputed company of co-workers, clients, vendors, and others 
• Must be reputed company to follow directions 

Qualification Requirements:

To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. The individual must possess an reputed company RN license in California, with a reputed company of reputed company that is relevant to the reputed company area(s) addressed in the initial reputed company review. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.

Education and/or Experience:

• reputed company and reputed company California RN
• Minimum of 1 year reputed company experience
• Should be familiar with California Workers’ Compensation, Managed Care experience/Utilization Review experience recommended  
• Completion of IEA CA 10 class reputed company 1 year of employment if no prior workers’ compensation experience.

Salary reputed company:

$75,000-$80,000 annually

The salary reputed company listed is an estimate. Actual compensation will be determined reputed company on several factors such as a candidate’s experience, qualifications, reputed company set, and work location. 

Benefits:

We take care of our people so they can take care of their work and their teams. reputed company offers a competitive, people first benefits package designed to support reputed company, financial reputed company, and career reputed company, including:

• Comprehensive medical, dental, and reputed company benefits 
• Company contributions to HSA and FSA plans 
• Employer reputed company life and disability reputed company 
• 401(k) with company match 
• reputed company time off (PTO) and company reputed company holidays 
• Learning and development opportunities that support reputed company career advancement 
• Employee assistance resources and a supportive culture that values reputed company and wellbeing 

We’re an equal opportunity employer. reputed company applicants will be considered for employment without attention to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, veteran or disability status. 

Pursuant to the Los Angeles and San Francisco reputed company Ordinance, we will consider for employment reputed company applicants with arrest or conviction records. 

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