162 nurse jobs found

You have a clear vision of where your career can go. And we have the leadership to help you get there.  At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.  Nurse Case Manager in a specialty area including but not limited to disability and medical case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, injured workers and claims professional staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: 1. Assesses disability status, makes recommendations, and identifies appropriate resources. 2. Accountable for gathering and coordinating medical evidence for...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This position will be in our Hartford, CT office during training, and once fully trained transition to a hybrid work arrangement.    ESSENTIAL...

Overview AmTrust Financial Services, a  fast growing  commercial insurance company, has a need for a Complex Care Case Manager, RN for Workers Compensation managed care team.     PRIMARY PURPOSE :   The  complex care case manager will provide comprehensive and quality telephonic case management for our injured employees with complex diagnoses and often catastrophic injuries. Our nurses will  be responsible for  proactively applying clinical  expertise  ensuring our injured employees receive medically  appropriate healthcare  to achieve a safe return to work or best  optimal  level of function through engagement with the injured employee,  provider  and employer. Our nurses will be empathetic informative medical resources for our injured employees, and they will partner with our adjusters to develop a personalized  holistic approach  for each claim.  These responsibilities may include  utilization  review, pharmacy oversight...

Who is Federated Insurance? At Federated Insurance , we do life-changing work, focused on our clients’ success. For our employees, we provide tremendous opportunities for growth. Over 95% of them believe our company has an outstanding future. We make lives better, and we’re looking for employees who want to make a difference in others’ lives, all while enhancing their own.   Federated’s culture is grounded in our Four Cornerstones: Equity, Integrity, Teamwork, and Respect.  We strive to create a work environment that embodies our values and commitment to diversity and inclusion.  We value and respect individual differences, and we leverage those differences to achieve better results and outcomes for our clients, employees, and communities.  Our top priority in recruitment and development of our next generation is to ensure we align ourselves with truly exceptional people who share these values. What Will You Do? Attention...

This is a Remote position.  Candidates must reside in the Central Valley, CA area.  This position is eligible for a company car. 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 of disability, treatment plans, functional abilities and physical job...

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...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Medical Case Manager, RN.   PRIMARY PURPOSE:  To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim.  These responsibilities may include utilization review, pharmacy oversight and care coordination.  Responsibilities Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional...

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including...

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim, Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors,...

Come join our team! There are many reasons why EPIC Insurance Brokers & Consultants has become one of the fastest-growing firms in the insurance industry. Fueled and driven by capable, committed people who share common beliefs and values and “bring it” every day, EPIC is always looking for people who have “the right stuff” – people who know what they want and aren’t afraid to make it happen. Headquartered in San Francisco and founded in 2007, our company has over 3,000 employees nationwide. With locations spread out across the U.S., our local market knowledge and industry expertise helps support our clients' regional and global needs. We have grown very quickly since our founding, and we continue to see growth and success thanks to our hard-working and growth-minded employees.  Our core values are: Owner mindset, Inspire trust, Think big, and Drive results. If these values and growth align with what you're looking for in your next career? Then consider joining our...

CorVel is seeking a Quality Assurance Nurse with experience in Case Management and Worker’s Compensation to conduct case management quality assurance audits. The Quality Assurance Nurse Auditor (QA Auditor) will serve a key role in ensuring patient and department records and processes are in compliance with policies, quality standards, workflow procedures, and regulatory and accreditation requirements. The QA Auditor will perform quality assurance audits for quality documentation and appropriate management of processes, maintain detailed auditing records, prepare trending reports, and monitor auditing results to support continuous innovation and compliance.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Develop, implement and provide ongoing quality assurance audit of processes both managed and delivered at the operational level. Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations....

Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Nurse - Medical Case Manager Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey. Our Medical Claims team is currently seeking a Legal Nurse Consultant in one of the following offices: Worcester, MA, Howell, MI or Richmond, VA.      At the Hanover we also understand that life and the workplace have changed so we have reimagined the workplace to provide flexible work arrangements that  provide better work life balance.  This position provides a flexible hybrid arrangement, with one or two days in the office.  There is flexibility for substantial remote work once established in the position.    The Hanover is a diverse and inclusive organization focused on hiring the best talent and we encourage all qualified professionals to apply.  We believe that an inclusive, diverse, and equitable...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey. Our Medical Claims team is currently seeking a Legal Nurse Consultant in one of the following offices: Worcester, MA, Howell, MI or Richmond, VA.      At the Hanover we also understand that life and the workplace have changed so we have reimagined the workplace to provide flexible work arrangements that  provide better work life balance.  This position provides a flexible hybrid arrangement, with one or two days in the office.  There is flexibility for substantial remote work once established in the position.    The Hanover is a diverse and inclusive organization focused on hiring the best talent and we encourage all qualified professionals to apply.  We believe that an inclusive, diverse, and equitable...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey. Our Medical Claims team is currently seeking a Legal Nurse Consultant to join our growing team in Itasca, IL.     At the Hanover we also understand that life and the workplace have changed so we have reimagined the workplace to provide flexible work arrangements that  provide better work life balance.  This position provides a flexible hybrid arrangement, with one or two days in the office.  There is flexibility for substantial remote work once established in the position.    The Hanover is a diverse and inclusive organization focused on hiring the best talent and we encourage all qualified professionals to apply.  We believe that an inclusive, diverse, and equitable workplace make us a better organization...

For more than 170 years, The Hanover has been committed to delivering on our promises and being there when it matters the most. We live our values every day, demonstrating we CARE through our values, ESG initiatives and IDE journey. Our Medical Claims team is currently seeking a Legal Nurse Consultant to join our growing team in Itasca, IL.     At the Hanover we also understand that life and the workplace have changed so we have reimagined the workplace to provide flexible work arrangements that  provide better work life balance.  This position provides a flexible hybrid arrangement, with one or two days in the office.  There is flexibility for substantial remote work once established in the position.    The Hanover is a diverse and inclusive organization focused on hiring the best talent and we encourage all qualified professionals to apply.  We believe that an inclusive, diverse, and equitable workplace make us a better organization...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.  Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with  diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a hybrid position out of our Pittsburgh, PA office.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the...

Company: Mercer Description: We are seeking a talented Registered Nurse Consultant to join our MercerWell team at Mercer. This role will be based in Phoenix, AZ or at one of our Mercer office locations in the US. This is a hybrid role that has a requirement of working at least three days a week in the office. As a Registered Nurse Consultant, you will impact patient outcomes by providing guidance to benefit administrators on opportunities for improved care coordination and case management. You will oversee the implementation of action plans to ensure administrator accountability and recognize areas where performance aligns with or exceeds best practices. We will count on you to:  Establish effective carrier/vendor relationships with assigned book of business to successfully represent Mercer and to serve our clients. Communicate Mercer's point of view on effective clinical management program models and strategies to manage potential and actual high-cost claimants....

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...