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Nurse Case Manager

Date: Jun 21, 2022

Location: Erie, PA, US, 16505

Company: Erie Insurance

Division or Field Office:

Claims Division

Department of Position: Medical Management Department 

Work from:

Home within ERIE's footprint

 

At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 5,000 employees and over 2,200 independent agencies.  Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.  To attract and retain the best talent, we reward our team members with competitive salaries and a very generous benefits package.

 

Position Summary

  • Bilingual, Spanish speaking preferred
  • This is a remote work from home position with the ideal candidate will live in the Maryland/Virginia/D.C area.
  • RN license in Maryland preferred
  • CCM preferred

 

Regularly exercises independent discretion and judgment in the coordination and management of the medical and disability process. Provides medical and rehabilitation consultation and education to claims personnel.

Duties and Responsibilities

  • Coordinates the injured workers' medical treatment to ensure both cost effective and medically appropriate care is provided.
  • Identifies inappropriate, experimental, overutilization or costly medical treatment.
  • Facilitates the return to work process by acting as a liaison between the insured, medical provider, injured worker and the claims handler. Prepares job analyses and obtains medical clearance for return to work.
  • Provides the claims handler with appropriate disability timeframes through the utilization of the Official Disability Guidelines.
  • Coordinates treatment plans for cases involving catastrophic injuries and complicated medical conditions.
  • Questions the causal relationship between the treatment and injury claimed.
  • Assists in identifying and evaluating providers and managed care vendors.
  • Oversees Vocational Rehabilitation activities in collaboration with the claims handlers.
  • Proactively manages and controls expenses through utilization of Erie's cost containment vendors.
  • Prepares medical cost projections and makes reserve recommendations upon request.
  • Provides medical education and guidance to claims handlers on complex files.
  • Maintains current knowledge of medical and rehabilitation trends.
  • The first six duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.
  • This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become evident.

Competencies

Values Diversity
Self-Development
Nimble Learning
Collaborates
Customer Focus
Cultivates Innovation
Instills Trust
Optimizes Work Processes
Ensures Accountability
Decision Quality

Qualifications

High school diploma, or GED, required. Current unrestricted Registered Nurse (RN) license in the state where the position is based and other assigned states as required by law. Bachelor of Science in Nursing (B.S.N.) and Certified Case Manager (C.C.M.) preferred. Three years experience in case management involving workers' compensation claims preferred. Five years clinical nurse experience with a preference for previous Orthopedic, Emergency Room, or Critical Care experience preferred. Incumbent must live in region assigned unless a change is approved by the company. Valid driver's license and good driving record required.

Physical Requirements

Lifting 0-20 lbs; Occasional (<20%)
Lifting 20-50 lbs; Occasional (<20%)
Lifting Over 50 lbs; Occasional (<20%)
Driving; Occasional (<20%)
Pushing/Pulling; Occasional (<20%)
Manual Keying/Data Entry; Frequent (50-80%)
Climbing; Rarely


Nearest Major Market: Erie