Disability Nurse Case Manager

The Disability Nurse Case Manager (RN) is responsible for the oversight and comprehensive review of assigned disability applications. The Disability Nurse Case Manager (Registered Nurse) will be responsible for an efficient, timely, and complete disability triage process. Preferred background in Case Management, Disability, Work Comp, Utilization Review, or Independent Review. Must have unrestricted Michigan RN license. Minimum 5 years clinical experience. Computer literate, excellent verbal/written skills. Competitive salary; health insurance benefits.

Job Duties:
• Conduct a thorough and comprehensive review of disability applications to determine the existence, nature, and severity of the disability condition(s).
• Compile applicable information through outreach to providers, disability applicants, employers, and other relevant parties.
• Review and analyze all information directly or indirectly related to the disability application and/or information obtained during the triage process.
• Perform outreach to the medical provider(s), disability applicant, employer, and other necessary parties to gather additional information and/or clarify information for the purpose of assisting in the decision-making process of the disability recommendation.
• Determine receipt of necessary and complete information to sufficiently perform the Clinical Review function.
• Identify the need for a case to be escalated to the leadership or MMRO’s Associate Medical Director for further review, inquiry, and/or decision-making.
• Complete system-generated tasks regarding specific cases within the scheduled timeframes and update the system accordingly upon completion and/or status with progress.
• Communicate case status and activities to members of the leadership team upon request.
• Ensure completeness and accuracy of all case paperwork and documents.
• Keep clients informed of case progress, including delays, and ensure timely and appropriate communication with clients on the status of open or pending cases, as requested.
• Perform quality assurance on physician reports to ensure adherence to statutory requirements and maintain high standards of accuracy in spelling, grammar, and punctuation.
• Select the appropriate physician specialty to review the claim based on the member's medical condition.
• Ensure all processes and reports comply with statutory requirements and organizational policies.
• Identify process quality improvement opportunities.
• Perform other duties, as deemed appropriate.

Required Qualifications and Education
• Unrestricted RN licensure, without sanctions, to practice in the State of Michigan
• Minimum five years clinical experience
• Working knowledge of diagnostic coding (i.e. ICD-10)
• Critical thinking skills
• Good decision-making skills
• Detail-oriented
• Ability to work autonomously, as well as within a team structure
• Computer literate
• Good working knowledge of MS Word and Excel
• Good communication skills
• Good telephonic speaking skills
• Ability to multi-task
• Good written and verbal skills

Preferred Skills and Additional Experience
• Bachelor's degree in nursing or health-related field
• Work experience to include case management and/or claim management of Disability and/or Workers’ Compensation claims.

Additional Notes
• The NCM is required to be on camera for all Teams meetings.

Job Type: Full-time

Pay: $74,000.00 - $80,000.00 per year

Benefits:
• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:
• 8 hour shift

Work Location: Remote

Apply Job!