TX, RN Certified Case Manager - Workers Compensation

Currently seeking TX, LA, OK RN for a full-time Pre Auth/ Certified Case Manager in the TX area (either Houston or DFW). The ideal candidate will be a RN with Pre Auth/Case Management experience in worker’s compensation and also certified in case management. Responsibilities of the RN Pre-Auth/ Certified Case Manager - Workers Compensation

• Conducts prospective review of authorization requests including selected specialties, medical treatments and services, elective hospital admissions, ancillary services, home care and out of network referrals. The nurse makes clinical decisions based on established criteria and regulatory requirements. Prepares documentation and manages the utilization of membership, conducts chart review for medical appropriateness of services, and ensures that quality care is delivered in a cost-effective, timely manner. The Pre-Authorization Nurse works in coordination with an interdisciplinary team to achieve the organization mission as well as department specific goals and objectives.
• Research and recommend resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate.
• Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.
• Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
• Works closely with injured worker, claims adjusters, employers, and medical providers to ensure best possible medical care is received for the Worker Compensation injury.
• Partner with claim professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
• Submit accurate billing documentation on all activities as outlined in established guidelines.
• Perform other duties assigned.
• Remote position- 85% telephonic & 15% field cases

Requirements of the RN Pre-Auth/Case Manager - Workers Compensation

• Graduate of an accredited school of Nursing with a BSN preferred
• Must be a Registered Nurse
• 3-5+ years nursing experience
• Workers' compensation and UR experience strongly preferred
• Strong technology, organizational and documentation skills a must
• Able to work independently, be proactive, and assertive.
• need to be a CCM

Benefits:

• NO HANDS-ON NURSING REQUIRED!!!!
• Remote position: DFW or Houston preferred location, will consider adjacent locations.
• Top Salary and excellent benefits including Health Insurance and 401K

Job Type: Full-time Pay: $80,000.00 - $90,000.00 per year Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible schedule
• Health insurance
• Life insurance
• Mileage reimbursement
• Paid sick time
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Willingness to travel:

• 25% (Required)

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