Nurse Case Manager

Join to apply for the Onsite Nurse Case Manager (Hybrid/Remote) role at MEM . Are you driven to keep people safe? That’s what we do every day at MEM Insurance. We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us. Summary The role of the Case Manager is to ensure patients have access to quality, cost-effective healthcare, and to assist in assessing, developing, and coordinating proactive plans for optimal outcomes in work injury cases. The case manager addresses early return to work and coordinates this with the policyholder, treating physicians, and claims representatives. The nurse case manager facilitates a safe, effective, early return to work, primarily through ongoing personal contact with all parties. Discretion may be used to determine whether this work is completed on-site or remotely. Essential Duties and Responsibilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Case Management Accepts case management assignments based on education, experience, and expertise. Collects and assesses data from referral sources and medical providers. Initiates contact with injured employees, policyholders, therapists, and medical providers as per standards. Coordinates and manages medical treatment plans for work injuries. Identifies necessary services and treatment options to promote quality care; recommends transfer of care when appropriate. Develops individualized medical treatment plans based on patient needs. Identifies gaps or inadequacies in treatment to prevent fragmented care. Directs care to in-network providers, vendors, and facilities. Medical Documentation & Communication Maintains communication with all claim parties. Records case management activities. Documents activities in the Claims Center system. Performs ongoing documentation per claims standards. Communicates treatment plans and return-to-work issues. Includes cost analysis when closing claims and documents savings. Maintains confidentiality and obtains necessary consents. Return-to-Work Coordination Evaluates the potential for return to work considering socio-economic factors. Establishes return-to-work targets collaboratively. Seeks light duty options for early return. Recommends vocational rehabilitation if needed. Sets achievable goals and updates all parties accordingly. Collaboration & Advocacy Acts as an advocate within the workers’ compensation system. Builds relationships with injured workers, families, and providers. Supports maximum medical improvement while controlling costs. Collaborates with the NCM team aligned with MEM’s mission, vision, and values. Professional Development & Representation Serves as a resource to claims and MEM staff. Explains nurse case management programs to customers. Mentors less experienced case managers. Represents MEM in professional activities. Attends conferences, seminars, and participates in meetings. Utilizes resources like Medical Director, Utilization Management, and ODG. Maintains current resources related to nurse case management. Administrative & Operational Tasks Manages calendar, daily activities, and travel. Reviews and manages medical records. Handles communication regarding treatment and return-to-work. Responds to calls, faxes, and emails. Enters data into the claims system. Researches medical information as needed. Participates in projects and staff meetings. Obtains continuing education units. Maintains communication with supervisor and updates on cases. Qualifications Education Associate degree in nursing, diploma RN, or bachelor’s in nursing. Designations/Certifications Preferred: Certification in Case Management from the Case Management Society of America. Licenses Current unencumbered RN license from Nebraska or a compact state (Missouri/Iowa). Valid Driver’s License. Experience Minimum three years nursing experience in Medical/Surgical or related areas. Five years insurance case management preferred. Skills Spanish bilingual preferred. #J-18808-Ljbffr