Disability/Worker's Comp Nurse Case Manager
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POST DATE 9/16/2016
END DATE 10/15/2016
Horizon Blue Cross Blue Shield of New Jersey
JOB DESCRIPTIONJob Summary:
Provides case management services for workers compensation cases with lost time, complex medical care, and/or high medical utilization. Ensures appropriateness and cost effectiveness of care, and optimal outcomes. Coordinates cases with internal and external claim representatives, clients, employees, providers and attorneys.
* Performs initial and ongoing review with employees/claimants, coordinates medical care, and communicates with providers and clients.
* Authorizes inpatient and outpatient services, and reviews bills for appropriateness utilizing HCS guidelines.
* Utilizes network providers to ensure appropriate treatment and services, where applicable.
* Documents all activities on existing claims systems including describing progress, treatment, and recommendations for the ongoing case management according to HCS and client guidelines.
* Attends in-services, seminars and meetings to maintain current knowledge level and licensure requirements.
* Performs other duties as assigned by management.
* Prefers understanding of case management philosophy and process.
* Requires knowledge of health care delivery system.
* Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
* Must be adaptable/flexible/customer focused
* Requires strong communication/organizational/problem solving/interpersonal and client relationship skills
* Prefers a Bachelor s degree.
* Requires a minimum of 2 years acute care experience, including medical/surgical, ER, orthopedics or neurology.
* Prefers minimum of one (1) year experience in home health, occupational medicine, rehabilitation, and/or Workers Compensation.
Additional licensing, certifications, registrations:
* Requires a current New Jersey RN License
* Prefers case management certification.
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status or status as an individual with a disability.