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TX, RN Certified Case Manager - Workers Compensation

The Reny Company -
Dallas, TX

Quick Apply

Job Details

Full-time
$80,000 - $90,000 a year

Benefits

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

Qualifications

Utilization review
RN License
Research
Case management
Clinical documentation
Workers' compensation
Certified Case Manager

Full Job Description

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)

Work Location: Remote

Quick Apply

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