AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Complex Care Case Manager, RN for Workers Compensation.
PRIMARY PURPOSE: The complex care case manager will provide comprehensive and quality telephonic case management for our injured employees with complex diagnoses and often catastrophic injuries. Our nurses will be responsible for proactively applying clinical expertise ensuring our injured employees receive medically appropriate healthcare to achieve a safe return to work or best optimal level of function through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees, and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.
Education & Licensing
Active unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. National Certification in case management OR the ability to obtain certification within 24 months of employment is required. (CCM, COHN, CRRN, etc). Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required. Written and verbal fluency in Spanish and English preferred
Minimum Five (5) years of related experience required to include two (2) years of direct clinical care AND three (3) years of combination of either case management/managed care setting/discharge planning/utilization management required.
Preferred previous clinical experience emergency room, critical care, home care or rehab experience.
Skills & Knowledge:
Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
Knowledge of behavioral health
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytic and interpretive skills
Strong organizational skills
Excellent interpersonal and negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
What We Offer:
AmTrust Financial Services offers a great work environment, competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical and Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, and Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
AmTrust Financial Services is committed to a policy of Equal Employment Opportunity.