9 Nurse jobs

Overview The Medical Management Nurse reports directly to the Director, Medical Case Management. Performs nursing interventions and/or telephonic case management activities, including prioritizing and managing a caseload of medical and disability workers’ compensation claims.   Has the responsibility of reviewing the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the AmTrust Claims Adjuster team to expedite medically necessary treatment for each claim. Will also review pharmacy authorizations to determine appropriateness of pharmaceutical treatment.       This candidate must be able to channel authorized treatment within the Medical Provider Network and effectively negotiate treatment plans. Provides medical case management through collaboration and communication to promote quality and cost-effective outcomes. Functions as a patient advocate. Responsibilities...

A career at Auto-Owners is challenging and rewarding.  Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs. Job Description We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, this specific role could have the flexibility to work from home up to 3 days per week. Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to: Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers’ compensation, personal injury protection (no fault), and liability. Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services. Prepare and deliver trainings to claims staff via a variety of modalities...

Company Details   Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases.   To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an...

Company Details   Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With our entrepreneurial culture and a strong emphasis on analytics, we can help employers better manage their risk. We offer a broad range of products, including employer stop loss, benefit captives, provider stop loss, HMO reinsurance, and specialty accident. The key to Berkley’s success is our nimble approach to risk – our ability to quickly understand, think through, and devise a plan that addresses each client’s challenges, coupled with the strong backing of a Fortune 500 company. Our parent company, W. R. Berkley Corporation, is one of the largest and best managed property/casualty insurers in the United States.   The company is an equal employment opportunity employer. Responsibilities We have an opportunity for a Registered Nurse, Clinical Risk Manager to...

This is a Remote Position for a candidate residing in the State of CA and can be filled in any Zenith CA Branch: San Diego, Orange, Woodland Hills, Fresno, Dublin, Roseville Eligible for a Company Vehicle Effectively conduct field case management, disability management, and utilization review as indicated for injured workers with the goal of returning the injured person to employability and normal activities or achieving maximum medical improvement (MMI). The essential functions of this position include, but are not limited to, the following: Prioritize and manage an assigned caseload of medical and disability workers' compensation claims according to Zenith guidelines, performing UR and field case management, as indicated. Communicate with injured employees, medical professionals, claims staff and employers timely and regularly to obtain information necessary to make sound medical assessments regarding diagnosis and prognosis. Assess injury severity, extent...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.  A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace®  Forbes Best-in-State Employer...

Foundation Risk Partners , one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Clinical Risk Management Manager to their  Cornell Insurance Services  team in the Edison, NJ office.  Job Summary: An insurance broker clinical risk management job description would detail a role focused on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, utilizing their medical expertise to analyze potential claims, advise clients on risk reduction strategies, and work with underwriters to secure appropriate coverage based on clinical risk factors.  Essential Functions: Clinical Risk Assessment: Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors. Detect and manage risk exposure Maintain and...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.  A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work® Most Loved Workplace®  Forbes Best-in-State Employer...

Position Summary The RN Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term disability claims. The RN Clinical Consultant identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Claim Managers in determining claim liability. The RN Clinical Consultant collaborates with treating providers to assist individuals to obtain appropriate care and ensure optimal treatment outcomes and acts with urgency and ownership to resolve customer issues and prioritize the customer experience. Candidate Responsibilities The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes. They must possess a strong clinical...