MEMIC is seeking a Registered Nurse to join our Managed Care Services department as a Nurse Case Manager. The Nurse Case Manager utilizes their expertise to resolve workers’ compensation claims by working with the injured worker to provide proper, efficient, timely and cost-effective healthcare services. The Nurse Case Manager does this through the processes of evaluation, assessment, planning, and implementation with the ultimate goal leading to a medically rehabilitated individual ready to return to an optimal level of work and functioning.
Conducts a comprehensive assessment of the injured worker physical and/or bio-psycho social needs in collaboration with the employer and medical provider to coordinate the medical care and return to work plan throughout the life of the claim.
Acts as a liaison between the injured worker, the medical provider, the employer as to medical rehabilitation issues and return to work.
Develops strategies to maximize medical outcomes in a cost effective manner.
Coordinates with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
Evaluates medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Works in collaboration with claim professionals as a medical resource to promote optimal outcomes.
Engages specialty resources as needed to achieve optimal resolution.
Bachelor’s Degree in Nursing preferred.
Registered Nurse with current, valid state licensure required.
National certification (CCM, CDMS, CRC, etc.) preferred
Minimum of two (2) years direct clinical care to consumers, industrial rehabilitation and/or occupational health nursing preferred.
Excellent communication (written and verbal), analytical and organizational skills are essential.
Ability to identify and resolve problems in a timely manner, while able to gather and analyze information.
Ability to demonstrate accuracy and thoroughness.
Must have proficient computer skills, including Microsoft Office programs.
Ability to set priorities and work independently is essential.
Ability to effectively manage a minimum caseload of 35 files.
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law.
Telecommuting is allowed.
The MEMIC Group includes MEMIC Indemnity Company, MEMIC Casualty Company, and parent company Maine Employers’ Mutual Insurance Company; all rated “A” (Excellent) by A.M. Best. As a super-regional workers’ compensation specialty insurer, The MEMIC Group holds licenses to write workers’ compensation across the country. The group insures more than 20,000 employers and their estimated 300,000 employees, and holds more than $1.3 billion in assets. The group maintains offices in Manchester, NH; Glastonbury, CT; Albany, NY; Weehawken, NJ; West Conshohocken, PA; Tysons Corner, VA; and Tampa, FL; in addition to its headquarters in Portland, ME.