Consultant Nurse jobs at Gallagher - 107 jobs

Under the supervision of the Director and/or Assistant Director of Nursing, the RN Shift Supervisor is responsible for the supervision of the Skilled Nursing facility for his/her particular shift. The RN Shift Supervisor is also responsible for all administrative and professional working policies pertaining to this section; and for supervising and delegating responsibilities to assure that clinical duties and unit activities are completed in order to provide quality patient care. The RN Shift Supervisor must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the residents served on his/her unit - adult through geriatric. The RN Shift Supervisor must demonstrate knowledge of the principles of growth and development over the life span; possess the ability to assess data reflective of the resident's status; interpret the appropriate information needed to identify each resident's requirements relative to their age-specific needs; and to provide the care needed as described in the Nursing Department's policies and procedures. Type of supervision exercised: full. Jobs reporting to this position: all disciplines in absence of Administration. EDUCATION: Graduate of an accredited Nursing Program required. Bachelor's degree from an accredited Nursing Program preferred. WORK EXPERIENCE: Minimum of three (3) years work experience as a Registered Nurse in a long-term care setting required with one (1) year in a supervisory capacity. SPECIAL EMPLOYMENT REQUIREMENTS: Must be cleared by PA State Police criminal history check. Possession of a current license as a Registered Nurse issued by the Pennsylvania State Board of Nurse Examiners required. Must have demonstrated administrative ability, supervisory capabilities and reliability. Good management skills required. CPR Certification required or must be obtained and must be maintained. Must maintain the standards of nursing care and implement the policies and procedures of the Nursing Department and Allied Services. Good verbal and written communication skills and interpersonal skills required for effective interaction with staff, residents and visitors. Must possess knowledge of Federal and State Regulations. PHYSICAL DEMANDS: Position involves bending, reaching, and stooping (occasionally in strained position) throughout shift. Ability to transport self throughout facility is required. ACCIDENT OR HEALTH HAZARDS: Occasional exposure to blood and body substances. Exposure to needle sticks possible. WORKING CONDITIONS: Works in resident living areas.

Under the supervision of the Director of Nursing, the Supervisor, RN Shift is responsible for the supervision of the Skilled Nursing facility for his/her particular shift. The RN Shift Supervisor is also responsible for all administrative and professional working policies pertaining to this section; and for supervising and delegating responsibilities to assure that clinical duties and unit activities are completed in order to provide quality patient care. The RN Shift Supervisor must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the residents served on his/her unit - adult through geriatric. The RN Shift Supervisor must demonstrate knowledge of the principles of growth and development over the life span; possess the ability to assess data reflective of the resident's status; interpret the appropriate information needed to identify each resident's requirements relative to their age-specific needs; and to provide the care needed as described in the Nursing Department's policies and procedures. Type of supervision exercised: full. Jobs reporting to this position: all disciplines in absence of Administration. EDUCATION: Graduate of an accredited Nursing Program required. Bachelor's degree from an accredited Nursing Program preferred. WORK EXPERIENCE: Minimum of three (3) years work experience as a Registered Nurse in a long-term care setting required with one (1) year in a supervisory capacity. SPECIAL EMPLOYMENT REQUIREMENTS: Clearances required: PA State Police criminal history check and PA Department of Aging FBI fingerprint clearance (if applicable). Possession of a current license as a Registered Nurse issued by the Pennsylvania State Board of Nurse Examiners required. Must have demonstrated administrative ability, supervisory capabilities and reliability. Good management skills required. CPR Certification required or must be obtained and must be maintained. Must maintain the standards of nursing care and implement the policies and procedures of the Nursing Department and Allied Services. Good verbal and written communication skills and interpersonal skills required for effective interaction with staff, residents and visitors. Must possess knowledge of Federal and State Regulations. PHYSICAL DEMANDS: Moderate Work: duties require exerting up to 25 lbs. of force occasionally (approx 10-33% of shift), and/or up to 10lbs. of force frequently (approx 33-66% of the time), and/or a negligible amount of force constantly to lift, carry, push, pull, and move objects (i.e., occasional patient transfers). Position involves bending, reaching, and stooping (occasionally in strained position) throughout shift. Ability to transport self throughout facility is required. ACCIDENT OR HEALTH HAZARDS: Occasional exposure to blood and body substances. Exposure to needle sticks possible. WORKING CONDITIONS: Works in resident living areas.

Under the general supervision of the Director of Nursing Services and/or the Assistant Director of Nursing Services, the RN Shift Supervisor is responsible for all administrative and professional working policies pertaining to this section; organizing or participating in educational programs; and delegating responsibilities to assure that clinical duties and unit activities are completed in order to provide quality patient care. The Shift Supervisor may assume supervision of the Nursing Department in the absence of the AVP Nursing/the Director of Nursing Services and the Assistant Director of Nursing Services. The RN Shift Supervisor must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his/her unit-adolescent through geriatric. The RN Shift Supervisor must demonstrate knowledge of the principles of growth and development over the life span; possess the ability to assess data reflective of the patient's status; interpret the appropriate information needed to identify each patient's requirements relative to the populations served by the hospital; and to provide the care needed as described in the Nursing Department's policies and procedures. Type of supervision exercised: full. Jobs reporting to this position: Nursing Department Staff EDUCATION: Graduate of an accredited Nursing Program required. CRRN preferred. Bachelor's of Science Degree in Nursing or equivalent work experience preferred. WORK EXPERIENCE: Minimum of five (5) years work experience as a Registered Nurse in a rehabilitation setting required. SPECIAL EMPLOYMENT REQUIREMENTS: Possession of a current license as a Registered Nurse as issued by the Pennsylvania State Board of Nurse Examiners required. Must have demonstrated administrative ability, supervisory capabilities and reliability. Working knowledge of Electronic Medical Records. CPR certification must be obtained and maintained. Clearances required: PA State Police criminal history check, PA Department of Public Welfare Child Abuse Central Register (Childline), PA Department of Human Services FBI fingerprint clearance and PA Department of Aging FBI fingerprint clearance (if applicable). PHYSICAL DEMANDS: Moderate Work: duties require exerting up to 25 lbs. of force occasionally (approx. 10-33% of shift) and/or up to 10 lbs. of force frequently (approx. 33-66% of shift). Position involves bending, reaching, stooping, and lifting (occasionally in strained positions) throughout shift. Position requires ability to transport self throughout facility. ACCIDENT OR HEALTH HAZARDS: Occasional exposure to blood and body substances. Exposure to needle sticks possible. WORKING CONDITIONS: Works in a well-lit nursing unit, which includes: nurse's station, patient rooms, treatment areas, etc.

Under the supervision of the Director of Nursing, the Supervisor, RN Shift is responsible for the supervision of the Skilled Nursing facility for his/her particular shift. The RN Shift Supervisor is also responsible for all administrative and professional working policies pertaining to this section; and for supervising and delegating responsibilities to assure that clinical duties and unit activities are completed in order to provide quality patient care. The RN Shift Supervisor must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the residents served on his/her unit - adult through geriatric. The RN Shift Supervisor must demonstrate knowledge of the principles of growth and development over the life span; possess the ability to assess data reflective of the resident's status; interpret the appropriate information needed to identify each resident's requirements relative to their age-specific needs; and to provide the care needed as described in the Nursing Department's policies and procedures. Type of supervision exercised: full. Jobs reporting to this position: all disciplines in absence of Administration. EDUCATION: Graduate of an accredited Nursing Program required. Bachelor's degree from an accredited Nursing Program preferred. WORK EXPERIENCE: Minimum of three (3) years work experience as a Registered Nurse in a long-term care setting required with one (1) year in a supervisory capacity. SPECIAL EMPLOYMENT REQUIREMENTS: Clearances required: PA State Police criminal history check and PA Department of Aging FBI fingerprint clearance (if applicable). Possession of a current license as a Registered Nurse issued by the Pennsylvania State Board of Nurse Examiners required. Must have demonstrated administrative ability, supervisory capabilities and reliability. Good management skills required. CPR Certification required or must be obtained and must be maintained. Must maintain the standards of nursing care and implement the policies and procedures of the Nursing Department and Allied Services. Good verbal and written communication skills and interpersonal skills required for effective interaction with staff, residents and visitors. Must possess knowledge of Federal and State Regulations.

The RNCM- bilig partners closely with Clinical Operations, Care Team Operations, Lead Care Managers, Community Health Workers, Behavioral Health providers, Compliance, and external medical and social service partners. Collaboration occurs daily to support assessments, care planning, escalations, transitions of care, and member outcomes. Responsibilities Conduct comprehensive clinical assessments (including medical history, risk factors, and medication review) and develop person-centered care plans with SMART goals based on medical, behavioral, and social needs. Provide medication reconciliation, health education, and condition-specific teaching to strengthen member understanding, self-management, and adherence. Collaborate with Lead Care Managers, CHWs, Behavioral Health, Housing Navigation, providers, and community partners to coordinate services and resolve medical and social barriers. Triage clinical concerns, identify red flags, and escalate appropriately to NP/MD partners; provide brief interventions within RN scope as needed. Participate in interdisciplinary Systematic Case Reviews (SCR), IDT meetings, and case conferences, offering clinical recommendations and follow-up planning. Coordinate transitions of care (TOC) by supporting post-hospital follow-ups, reconciling medications, scheduling timely appointments, and ensuring continuity. Maintain accurate, timely, audit-ready documentation in ECW, Google Suite, and payer/health plan portals; ensure all clinical assessments, screenings, and care plans meet required timelines. Engage members through relationship-based and trauma-informed approaches, building trust with individuals who may struggle with traditional healthcare systems. Identify gaps in care, clinical risk, or environmental barriers and collaborate with care teams to implement timely interventions. Support HHN's startup model by adapting to evolving workflows, contributing to clinical process improvements, and helping build scalable care coordination practices. Skills Required Strong clinical assessment, triage, and critical-thinking skills, bilingual speaking, writing. Expertise in care planning, chronic disease management, and clinical documentation. Proficiency with eClinicalWorks (ECW), Google Suite, RingCentral, and payer/health plan portals. Ability to interpret labs, vitals, diagnostics, and clinical red flags to guide care decisions. Strong medication knowledge and ability to perform accurate medication reconciliation and provide member education. Experience supporting members with complex medical, behavioral health, and social needs. Ability to work independently while effectively partnering with a multidisciplinary team. Excellent written and verbal communication skills with demonstrated cultural humility and trauma-informed communication. Strong organizational and time-management skills; able to manage multiple high-acuity cases simultaneously. Comfort working in a fast-paced, evolving startup environment with shifting workflows and new processes. Reliable HIPAA-compliant remote workspace with stable internet connection. Competencies Clinical Judgment: Applies strong nursing assessment and evidence-based decision-making. Collaboration: Works effectively across interdisciplinary teams and external partners. Problem Solving: Identifies issues early and develops practical solutions quickly. Communication: Delivers clear education, instruction, and support to diverse populations. Adaptability: Thrives in ambiguity, adjusts quickly to changes, and supports startup operations. Cultural Competence: Engages respectfully with diverse and vulnerable populations. Quality Focus: Maintains high standards for documentation, timeliness, and compliance. Member-Centered Care: Approaches each member with empathy, respect, and a commitment to holistic care. Job Requirements Education: Associate or Bachelor's degree in Nursing required; BSN strongly preferred. Licensure: Active, unrestricted Registered Nurse (RN) license in the state of California. Experience: Minimum 3 years of nursing experience. Bilingual - Spanish At least 1 year in care management, case management, or complex care coordination. Experience with chronic disease management, behavioral health integration, or ECM preferred. Experience managing members with high medical, behavioral, or social complexity. Familiarity with Medi-Cal populations, health plans, and care management best practices.

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

Job Description Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions. You will report into the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines Meet required decision-making SLAs Refer members for further care engagement when needed Compliance with all applicable laws and regulations Other duties as assigned Requirements: Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing MCG or InterQual tooling experience Ability to obtain additional state licenses to meet business needs 1+ year of utilization review experience in a managed care setting 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital) Bonus points: BSN Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: Support internal claims adjusting staff in the review of workers' compensation claims Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone Meet required decision-making timeframes Clearly document all communication and decision-making within our insurance software system Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys Utilize good clinical judgment, careful listening, and critical thinking and assessment skills Track ongoing status of all UR activity so that appropriate turn-around times are met Maintain organized files containing clinical documentation of interactions with all parties of every claim Send appropriate letters on each completed UR Salary Range $65,000.00 - $100,000.00 USD The successful candidate is expected to work in one of our offices 3 days per week and also be available for travel as required. The annual base salary range posted represents a broad range of salaries around the U.S. and is subject to many factors including but not limited to credentials, education, experience, geographic location, job responsibilities, performance, skills and/or training. Qualifications Active Licensed Practical Nurse and/or Registered Nurse License 1+ years of utilization review experience at a managed care plan or provider organization 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review Excellent oral and written communication skills, including outstanding phone presence Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environment The ability to set priorities and work both autonomously and as a team member Well-developed time-management and organization skills Excellent analytical skills Working knowledge of: Microsoft Word, Excel, and Outlook

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

About us: Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett's Berkshire Hathaway group - one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide. Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company's success is grounded in our core values: accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path! Benefits: We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You'll be surprised by all we have to offer! Competitive compensation Healthcare benefits package that begins on first day of employment 401K retirement plan with company match Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays Up to 6 weeks of parental and bonding leave Hybrid work schedule (3 days in the office, 2 days from home) Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation) Tuition reimbursement after 6 months of employment Numerous opportunities for continued training and career advancement And much more! Responsibilities The Utilization Review Nurse's duties will include, but are not limited to: Support internal claims adjusting staff in the review of workers' compensation claims Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone Meet required decision-making timeframes Clearly document all communication and decision-making within our insurance software system Establish collaborative relationships and work as an intermediary between clients, patients, employers, providers, and attorneys Utilize good clinical judgment, careful listening, and critical thinking and assessment skills Track ongoing status of all UR activity so that appropriate turn-around times are met Maintain organized files containing clinical documentation of interactions with all parties of every claim Send appropriate letters on each completed UR Qualifications Active Licensed Practical Nurse and/or Registered Nurse License 1+ years of utilization review experience at a managed care plan or provider organization 2 + years' clinical experience preferably in case management, rehabilitation, orthopedics, or utilization review Excellent oral and written communication skills, including outstanding phone presence Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environment The ability to set priorities and work both autonomously and as a team member Well-developed time-management and organization skills Excellent analytical skills Working knowledge of: Microsoft Word, Excel, and Outlook

Nurse Reviewer PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely. Essential Duties and Responsibilities: Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD&D, voluntary life/AD&D, 401k For immediate consideration, please apply via the HQSI Careers Page at: ************ > Careers > Current Employment Opportunities EOE: Minorities/Females/Disabled/Veterans Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace Healthcare Quality Strategies, Inc. is an E-Verify Employer

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. Nurse Case Manager in a specialty area including but not limited to disability and psychiatry case management. Makes assessments and determinations applying various case and disability management principles within area of specialty. Ensures expeditious and effective claims decisions through collaboration with healthcare providers, employers, claimants and claims staff. JOB DESCRIPTION: Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: * Assesses disability status, makes recommendations and identifies appropriate resources. * Accountable for gathering and coordinating medical evidence for evaluation of functionality and makes assessments on restrictions and limitations and assigns length of disability. * Consults on case management issues in area of specialty and applies effective case management interventions. * Collaborates with medical and other providers to ensure appropriate treatment and return to work. * Facilitates job modifications when appropriate and educates involved parties regarding claims process and functionality as it relates to job requirements while remaining externally focused. * Addresses causality and refers to appropriate medical expertise. * Documents according to jurisdictional, departmental and accreditation requirements. Reporting Relationship Typically Lead Specialty Nurse Case Manager Skills, Knowledge and Abilities * Strong knowledge of case management, specialty area, medical terminology and conditions, insurance industry as well as company policies and procedures. * Ability to exercise professional judgment and assume responsibility for decisions which have an impact on people, costs and quality of service. * Excellent verbal, written, and presentation skills with the ability to convey technical issues in a clear, concise and effective manner. * Strong interpersonal skills with the ability to effectively interact with internal and external business partners. * Detail oriented with strong organizational and analytical skills as well as the ability to prioritize and coordinate multiple tasks. * Knowledge of Microsoft Office Suite as well as other business related software. * Ability to work independently. Education and Experience * RN with BSN preferred. Eligible to sit for national case management certifications. * Typically a minimum five years diverse clinical background, with two or more years disability management experience preferred #LI-AR1 #LI-Hybrid In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $54,000 to $103,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visit cnabenefits.com. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact ***************************.

Job Description Hi, we're Oscar. We're hiring a Case Management Nurse to join our Case Mangement team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members. You will report into the Associate Director, Clinical. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care) Actively reach out to members undergoing difficult health challenges and develop care plans Proactively reach out to hospital case managers to assist with discharge planning Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license Ability to obtain additional state licenses to meet business needs 2+ years of clinical experience to include payer, hospital, outpatient or community based care management 1+ years of experience in Care Coordination and Navigation Bonus points: CCM Certification Bilingual in Spanish and/or creole reading, writing, speaking BSN Working knowledge of Milliman Guidelines This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

Hi, we're Oscar. We're hiring a Case Management Nurse to join our Case Mangement team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members. You will report into the Associate Director, Clinical. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year. Responsibilities: Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care) Actively reach out to members undergoing difficult health challenges and develop care plans Proactively reach out to hospital case managers to assist with discharge planning Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures. Compliance with all applicable laws and regulations Other duties as assigned Requirements: Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license Ability to obtain additional state licenses to meet business needs 2+ years of clinical experience to include payer, hospital, outpatient or community based care management 1+ years of experience in Care Coordination and Navigation Bonus points: CCM Certification Bilingual in Spanish and/or creole reading, writing, speaking BSN Working knowledge of Milliman Guidelines This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our .

DETAILS Telephonic Nurse Case Manager Department: Managed Care Reports To: Case Management Supervisor FLSA Status: Exempt Job Grade: 14 ATHENS ADMINISTRATORS Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for a full-time Telephonic Nurse Case Manager to support our Managed Care Department. The position can be located remotely from California, Colorado, Nevada, Texas, Oregon, Idaho, Arizona, or Oklahoma if technical requirements are met. This position will work M-F from 9am to 5pm Pacific time schedule regardless of time zone. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. The Telephonic Nurse Case Manager researches and recommends resources and creates flexible, cost-effective options for injured, catastrophically, or chronically ill individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate. This position will assist the unit in maintaining a successful program which may include helping develop workflows, reporting, staff recruitment and training. PRIMARY RESPONSIBILITIES Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned: Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties. Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services. Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations). Schedules appointments to avoid delays in treatment by primary care physicians, specialists, or ancillary services. Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary. Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved. Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports. Develops Independent Medical Evaluation Plan. Provides assessment, planning, implementation, and evaluation of patient's progress Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed. Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim. Work with the treating physician to update any conditions as medical treatment progresses Assesses the injured worker and his/her support system and family. Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment, ensuring the job is consistent with any physical restrictions assigned by the treating doctor. Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force. Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan. Research medical and community resources for patients with catastrophic or chronic diagnoses, such as but not limited to, AIDS, cancer, spinal cord injury, diabetes, head injury, back injury, hand injury, burns, et cetera. Maintains constant contact with the adjuster assigned to the file through telephone calls, email, and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer. Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers' compensation and federal laws that impact the delivery of health care and return to work May be requested to attend doctor and/or attorney visits, hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy as deemed necessary. Assist the overall unit with development of workflows, best practices, reporting templates, and training needs as deemed necessary. Requires regular and consistent attendance May be asked to travel to other branches for training or file reviews as needed. Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) ESSENTIAL POSITION REQUIREMENTS The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations. A Master's or Bachelor's degree in nursing or an Associate's Degree in Nursing from an accredited school, along with equivalent work experience, is required CCM, CIRS, CRRN, COHN or other related designation preferred Master's or Bachelor's degree in related field with a CCM, CDMS, or CRC or other related designation preferred Active RN license from any US state required at time of hire Current RN licensure in CA required within one year of hire (if not already obtained) California RN application submitted within the first two weeks of hire. Athens reimburses licensing fees 3+ years' workers' compensation case management experience or related field required Strong clinical background in orthopedics, neurology, or rehabilitation useful Strong cost containment background, such as utilization review or managed care also useful Extensive clear and tactful communications required via writing, reading, telephone calls, note taking, letter writing, memoranda, etc. Strong negotiation skills The ability to work effectively with minimal direct supervision Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company. APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at *********************************************** Feel free to include a cover letter if you'd like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: ************************************************************************************************** This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development. THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. Strong interpersonal and relationship building skills. Knowledge of traumatic injuries and the resultant disabilities and medical complications. Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. Experience using Microsoft Office products and ability to learn other technology tools. Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: Complete timely initial assessment report, case management plan, and establish disability duration timeframes. Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. Active participation with claims team to review, establish, and execute action plan. Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. Work collaboratively with all stakeholders to effectively manage recovery and return to work process. Meet productivity requirements. Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. Compact license preferred. 3-year experience in Workers Compensation Case Management preferred. Proficiency with MS Office products Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. Strong interpersonal and relationship building skills. Knowledge of traumatic injuries and the resultant disabilities and medical complications. Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. Experience using Microsoft Office products and ability to learn other technology tools. Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: Complete timely initial assessment report, case management plan, and establish disability duration timeframes. Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. Active participation with claims team to review, establish, and execute action plan. Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. Work collaboratively with all stakeholders to effectively manage recovery and return to work process. Meet productivity requirements. Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. Experience in handling Texas jurisdiction Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. Compact license preferred. 3-year experience in Workers Compensation Case Management preferred. Proficiency with MS Office products The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

FUNCTION OF THE JOB: The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position KNOWLEDGE AND SKILLS: * Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. * Strong interpersonal and relationship building skills. * Knowledge of traumatic injuries and the resultant disabilities and medical complications. * Knowledge of Worker's Compensation Acts and working knowledge of the medical providers in the assigned territory. * Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines. * Experience using Microsoft Office products and ability to learn other technology tools. * Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines MAJOR DUTIES/RESPONSIBILITIES OF THE JOB: * Complete timely initial assessment report, case management plan, and establish disability duration timeframes. * Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan. * Active participation with claims team to review, establish, and execute action plan. * Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines. * Work collaboratively with all stakeholders to effectively manage recovery and return to work process. * Meet productivity requirements. * Effectively manage inventory based on guidelines. EDUCATION AND EXPERIENCE: * Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed. BSN preferred. * Certified Case Manager (CCM) certification, CDMS and/or CRRN preferred. * Compact license preferred. * 3-year experience in Workers Compensation Case Management preferred. * Proficiency with MS Office products * Bi-lingual in Spanish a plus The pay range for the role is $65,900 to $111,900. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.