Workers Compensation Nurse Case Manager

About The Role  Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers' Compensation and other Casualty clients.  The Workers' Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan.  The Nurse Case Manager reports to the Casualty Department Manager.   This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.   Primary Responsibilities  Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work.  Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines.  Knowledgeable and compliant with New York State Workers' Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process.  Proven ability to anticipate claimant's treatment or recovery milestones.  Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives.  Facilitates and expedites discharge planning as needed.  Produces accurate electronic records of individual cases.  Ensures timely, cost-effective medical care for injured workers' recovery.  Answers provider calls and assists with Casualty Department workload as necessary.  Adheres to established quality assurance standards and MagnaCare policies and procedures.  Essential Qualifications  Currently licensed Registered Nurse in the state of NY, or the ability to obtain.  Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged.  Minimum 1 year experience in worker's compensation case management.  Bachelor's degree preferred.  Minimum of 4 years' experience in a clinical environment required.  Strong skills in medical assessment/medical record review.  Excellent customer service skills.  Ability to define and solve problems, collect data, establish facts and make effective decisions a must.   Must be detail oriented and have strong organizational and time management skills, and the ability to work independently.   Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook.  About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions. Come be a part of the Brightest Ideas in Healthcareâ„¢. Company Mission Transform the health plan experience - how health care is accessed and delivered - by bringing outstanding products and services to our partners. Company Vision Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways. DEI Purpose Statement  At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.   Annual Salary Range: $70,000 - $85,000 The salary range and/or hourly rate listed is a good faith determination that may be offered to a successful applicant for this position at the time of the posting of an advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable by law including but not limited to location, years of relevant experience, education, credentials, skills, budget and internal equity. *We are an Equal Opportunity Employer JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to:

Created: 2024-11-21