116 rn jobs found

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic 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...

CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in.   Work from home, and on the road. Monday – Friday, regular business hours.   As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families.  Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others.  This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source Utilizes their medical and nursing knowledge to discuss the...

The Medical Allocator creates a cost projection of a patient’s medical treatment needs by reviewing medical records and identifying a pattern of care. The medical cost projection, also knowns as a Medicare Set-Aside (MSA) report, is part of a workers’ compensation or liability claim settlement.  The Medical Allocator will rely on their medical knowledge and guidelines provided by the Centers for Medicare and Medicaid Services (CMS) to evaluate the patient’s treatment plan for future medical treatment needs.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collaboration with the claim adjuster Review medical records to prepare a Medicare Set-Aside allocation (MSA) report Perform evidenced based medical research Utilize medical knowledge to outline the patient’s medical treatment. Assign pricing to medical treatment allocations Assign pricing to medication allocations Prepare submission of MSA report to CMS for review and approval...

The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment, certifies the medical necessity and assigns an appropriate length of stay; supporting the goals of the Case Management department, and of CorVel. This is a remote role.    ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Identifies the necessity of the review process and communicates any specific issues of concern to the appropriate claims staff/customer. Collects data and analyzes information to make decisions regarding certification or denial of treatment. Documenting all work in the appropriate manner. Requires regular and consistent attendance. Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP). Additional duties as required.   KNOWLEDGE & SKILLS:  Must have a thorough knowledge of both CPT and...

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) For Supervisors who are not RN’s, the clinical oversight and direction will be performed by a designated RN with a nationally...

Remote from home— with local presence for occasional visits. Providing quality service and accurate results supports Ascential Care Partner’s primary mission as a trusted adviser to our clients. As Nurse Case Manager (full, or hybrid), you will be working in a fast-growing company and work environment. Your valuable role requires working closely with treating physicians/providers, employers, claim representatives, legal representatives, and the injured/ disabled person to create and implement safe and effective Return to Work plans, and facilitate appropriate and cost-effective medical services to achieve maximum medical improvement and recovery. As a member of our team, you will continue to reinforce Ascential’s mission of being a market leader and collaborative partner to current and prospective customers and partners. Job Duties: Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions. Case Management &...

Providing quality service and accurate results supports Ascential Care Partner’s primary mission as a trusted adviser to our clients. As a Telephonic Nurse Case Manager, you will be working in a fast-growing company and work environment. Your valuable role requires working closely with treating physicians/providers, employers, claim representatives, legal representatives, and the injured/ disabled person to create and implement safe and effective Return to Work plans, and facilitate appropriate and cost-effective medical services to achieve maximum medical improvement and recovery. As a member of our team, you will continue to reinforce Ascential’s mission of being a market leader and collaborative partner to current and prospective customers and partners. Job Duties: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Case Management & Application of Knowledge: Demonstrate and apply knowledge of case...

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) For Supervisors who are not RN’s, the clinical oversight and direction will be performed by a designated RN with a nationally recognized...

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) For Supervisors who are not RN’s, the clinical oversight and direction will be performed by a designated RN with a nationally...

CorVel Corporation is hiring a full time caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Springfield, MO area. *Must live in or around Springfield, MO area* Work from home, and on the road.  As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. Responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to discuss the...

CorVel Corporation is hiring a full time caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Overland Park, KS area. *Must live in or around Overland Park, KS area* Work from home, and on the road.  As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. Responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others. Utilizes their medical and nursing knowledge to discuss the...

The Medical Allocator creates a cost projection of a patient’s medical treatment needs by reviewing medical records and identifying a pattern of care. The medical cost projection, also knowns as a Medicare Set-Aside (MSA) report, is part of a workers’ compensation or liability claim settlement.  The Medical Allocator will rely on their medical knowledge and guidelines provided by the Centers for Medicare and Medicaid Services (CMS) to evaluate the patient’s treatment plan for future medical treatment needs.  Work from home possible.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Collaboration with the claim adjuster Review medical records to prepare a Medicare Set-Aside allocation (MSA) report Perform evidenced based medical research Utilize medical knowledge to outline the patient’s medical treatment. Assign pricing to medical treatment allocations Assign pricing to medication allocations Prepare submission of MSA report to CMS for review and approval...

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote position. ESSENTIAL FUNCTIONS &RESPONSIBILITIES: Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised Requires regular and consistent attendance Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities...

The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers’ reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claim Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status Directs callers to appropriate medical and/or claim resources Identifies and communicates urgent situations related to treatment or patient condition directly to the...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a Remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Field Case Manager-Sign-On Bonus Eligible This Field Case Manager will cover our Fairfax/Chantily, VA region and MUST live in this area in order to be considered. PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers t o facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties....

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Field Case Manager-Sign-On Bonus Eligible This Field Case Manager will cover our Virginia Beach, Norfolk, & Chesapeake, VA region and MUST live in this area in order to be considered. PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers t o facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between...

Overview AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic 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...

CERiS in Fort Worth, Texas is seeking a DRG Quality Control/Clinical Auditor. The Diagnostic Related Groups (DRG) QC Clinical Auditor will be responsible for performing quality control DRG validation (clinical/coding) reviews of internal audit team reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided. This involves completing medical records review, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination, as well as communicating missed or incorrect information to the auditors in a professional manner. Experience using, ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. This is a remote position. Job Duties and Responsibilities: The Quality Control...

The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding) reviews of medical records and/or other documentation. This role will determine correct DRG/coding as defined by review methodologies specific to the type of review. This involves completing medical record reviews, accurately documenting findings and non-findings and providing clinical/policy/regulatory support for the determination. This role will utilize their experience with ICD-10-CM & PCS coding guidelines, the ability to understand modern pharmacology, disease management and clinical intervention procedures. The ideal DRG Clinical Auditor candidate has strong written and verbal communication skills, clinical knowledge of disease processes, and knowledge of medical necessity rules. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through...