Investigate, evaluate, and manage the medical issues in workers’ compensation claims and other casualty claims to determine causation, medical necessity, and relatedness to the alleged injury event with focus on the quality and appropriateness of medical care and services. Coordinate communication between the medical provider, insured, and injured worker to facilitate early return to work.
Position Responsibilities
Provide telephonic case management and develop a plan of action to manage the medical issues on certain workers’ compensation claims by contacting the injured employees’ medical providers to review diagnosis, treatment plan, and ability to continue working.
Review in-depth medical information relating to various casualty claim types involving causality, utilization review, as well as accuracy of billing, diagnosis, and prognosis.
Work in a team environment coordinating claims strategy as it relates to the medical issues, accepted treatment guidelines and rules established by the state of jurisdiction.
Position Requirements
A diverse nursing background
Experience in orthopedic nursing a plus
Experience with telephone triage a plus
Strong oral and written communication skills
Strong analytical and problem-solving skills
PC skills
A desire to expand your nursing knowledge
Permanent authorization to work in the United States
For consideration, please send your confidential resumé and salary history to lajakobitz@fedins.com.
