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Combined Insurance WORKERS COMPENSATION NURSE CONSULTANT in United States

_BASIC FUNCTION OF THE JOB:_

TheNurse Consultantis an integral member of the Workers Compensation Claims unit and is responsible for the oversight of the medical management program within the assigned service and location areas. The key functions of the job include: * Managing a team of Telephonic Case Managers; * Participating in the recruiting and hiring process; * Onboarding of new hires and ongoing training to ensure employees are aware of medical and disability management processes, goals and related workflows; * Collaborating with the leadership team to provideongoing education and training for the claims staff on all aspects of medical claim management; and * Participating in special projects or other initiatives to further the strategic priorities of the medical management team.

The Nurse Consultant responsibilities also include utilizing triage criteria for TCM, FCM and MMS referrals, providing appropriate oversight of the external case management providers, providing insight on medical treatment costs as well as procedures, overseeing vendor management and evaluating the appropriateness of treatment and costs to assist adjusters with overall claim exposure. The Nurse Consultant provides catastrophic case management oversight and direction for severe claims. Other key functions of the role of the Nurse Consultant include the implementation of Chubb’s managed care program for insureds, coordinating the development of medical panels as appropriate, monitoring managed care regulations and staying current on medical trends. The Nurse Consultant partners with Underwriting and Claim Business Consultants to market Chubb’s managed care program to existing and prospective accounts. The Nurse Consultant maintains ongoing communication with the claim and underwriting staff and serves as a liaison to assist with oversight of the managed care program for insureds. *_KNOWLEDGE AND SKILLS:_* * *

* Prior Workers Compensation case management experience and/or management of the medical aspects of these claims. * Catastrophic Case Management and Life Care Planning expertise. * Excellent platform and communication skills. * Knowledge of general industry trends and legislative activities with regard to the managed care industry and workers compensation tort reform. * Knowledge of medical resources and facility providers. * Expertise in utilization review and treatment protocols for workers compensation claims. * Prior experience managing programs and supervising people is preferred.

*_MAJOR DUTIES/RESPONSIBILITIES OF THE JOB_*:

* Manage a team of telephonic nurse case managers. * Provide ongoing education and training for the claims staff on all aspects of medical claim management. * Implement criteria for referral to case management along with appropriate oversight.
* Ensure team of assigned nurses manage their assignments in accordance with applicable guidelines to include providing directional input / coaching as needed and completing quarterly audits of the work product. * Provide insight on medical treatment costs as well as procedures, and evaluate the appropriateness of treatment and costs to assist adjusters with overall claim exposure. * Provide catastrophic case management and direction for severe claims. * Oversee outside vendors including compliance with national standards. * Analyze medical trends, provide cost containment results for the territory and execute medical management strategies to improve overall claim costs in conjunction with the national medical program. * Implement Chubb’s managed care programsfor insureds and coordinate the development of medical panels as appropriate. * Partner with Underwriting and Claim Business Consultants to market Chubb’s managed care program to existing and prospective accounts. The Nurse Consultant maintains ongoing communication with the claim and underwriting staff and serves as a liaison to assist with oversight of the managed care program for insureds. * Monitor managed care regulations and stay current on medical trends.

*KNOWLEDGE AND SKILLS:*

  • Prior Workers Compensation case management experience and/or management of the medical aspects of these claims.
  • Catastrophic Case Management and Life Care Planning expertise.
  • Excellent platform and communication skills.
  • Knowledge of general industry trends and legislative activities with regard to the managed care industry and workers compensation tort reform.
  • Knowledge of medical resources and facility providers.
  • Expertise in utilization review and treatment protocols for workers compensation claims.
  • Prior experience managing programs and supervising people is preferred. _ _ _ _ _EDUCATION AND EXPERIENCE:_

  • Bachelor of Science, Nursing preferred.

  • Active RN License required.
  • Certified Registered Rehabilitation Nurse (CRRN), Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Must possess any one or a combination of certifications coming into the position and maintain current licensure and certification throughout their tenure.
  • Prefer 8-10 years of nursing experience with 3-5 years in insurance rehabilitation, utilization review, managed care and telephonic case management experience.

* *

Job: *Claims

Title: WORKERS COMPENSATION NURSE CONSULTANT

Location: null

Requisition ID: 331009

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