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Nurse Case Manager (The Mutual Group) - Remote Opportunity
GuideOne Insurance Dallas, TX

Nurse Case Manager (The Mutual Group) - Remote Opportunity

GuideOne Insurance
Dallas, TX
Expired: over a month ago Applications are no longer accepted.
  • Vision , Medical , Dental , Paid Time Off , Life Insurance , Retirement
  • Full-Time
Job Description
Company Info
Job Description


The Mutual Group (TMG) is a comprehensive, integrated insurance operations platform dedicated to helping mutual insurance companies. We offer access to a modern, professional operating platform, including surplus support, technology, claims, underwriting, finance and a broad range of other resources for our members. We’re new, and we’re growing!

As a Nurse Case Manager, you will provide telephonic medical case management on worker's compensation claims with emphasis on early intervention and return to work planning. You will coordinate quality medical care on claims involving disability and medical treatment, as well as in-house medical reviews as applicable to claim handling laws and regulations. You will ensure injured workers receive appropriate and timely medical care and assist claim adjusters in managing medical treatment to an appropriate resolution.

Responsibilities:

  • Effectively manages assigned caseload of medical/disability worker's compensation cases within company and regulatory guidelines.
  • Communicates with claimants, medical professionals, claims staff and others to obtain information necessary to make sound medical decisions. In addition, responds to various written, telephonic inquiries regarding status of case or needed authorizations for treatment.
  • Documents adjuster claim file on medical status and return to work strategy.
  • Develops strategies to facilitate an injured employee’s return to work and achieve maximum medical improvement.
  • Evaluates and updates treatment and return to work plans within established protocols throughout the life of the claim.
  • Partners with Claims adjusters to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
  • Attends Worker’s Compensation departmental staff meetings.
  • Performs other related work as assigned.

Required Qualifications:

  • Associates Degree in Nursing
  • Registered Nurse
  • Certified Nurse Case Manager designation preferred.
  • Three (3) years of experience in providing nurse case management services or equivalent.
  • CCM required, multi-state/compact licensure in primary state of residence required. Would also consider candidate with multiple RN state licensures if not in a multi-state jurisdiction.
  • Familiarity with multi-jurisdictional rules and regulations preferred.
  • Ability to obtain and maintain additional professional RN licenses and/or any state mandated registrations and training as indicated based on company needs.
  • Worker's compensation related case management experience.
  • CA licensure a plus.

Recommended Qualifications:

  • Bilingual a plus.
  • Knowledge of WC telephonic nurse case management work processes & MPN network referral guidelines.
  • Strong communication skills with effective and accurate written, verbal and listening abilities.
  • Customer service oriented.
  • Strong organizational skills which support timely and well documented action.
  • Working knowledge of Microsoft Office, Excel, and Outlook.
  • Interpersonal skills as well as an ability to work with multiple teams within the organization to reach common goals.
  • Good negotiation skills to effectively establish target return to work dates.
  • Familiarity with URAC standards and analytical thinking.
  • Ability to analyze and explore alternative solutions that support sound decision-making.

Compensation:

  • $66,000 - $110,000 commensurate with experience, plus bonus eligibility
  • $72,600 - $121,000 commensurate with experience in CA, CT, MA, NJ, NY, and PA, plus bonus eligibility

*The successful candidate will initially be hired as an employee of GuideOne Insurance Company and automatically become an employee of TMG on the company's official transition date.

Benefits:

We are proud to offer a robust benefits suite that includes:

  • Competitive base salary plus incentive plans for eligible team members
  • 401(K) retirement plan that includes a company match of up to 6% of your eligible salary
  • Free basic life and AD&D, long-term disability and short-term disability insurance
  • Medical, dental and vision plans to meet your unique healthcare needs
  • Wellness incentives
  • Generous time off program that includes personal, holiday and volunteer paid time off
  • Flexible work schedules and hybrid/remote options for eligible positions
  • Educational assistance

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