Job Description

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.

PURPOSE OF THE JOB

The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate medical treatment and length of disability with providers and employers while managing financial and other risks on behalf of the Company.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Creates and manages worker's compensation patient case plans with ongoing monitoring to ensure quality and appropriate service delivery of the case management process.

• Performs initial and ongoing clinical assessment via telephone calls to relevant parties that may include the injured worker, physician, attorney or other parties .
• Assesses client's situation for psychosocial needs, cultural implications and ensures support systems are in place.
• Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria.
• Monitors ongoing progress toward established goals and objectives.
• Implements plan through case management interventions and communication with all parties to reach desired goals and objectives.

Measures effectiveness of treatment plans and creates alternate strategies when needed.

• Recommends need for alternative treatment plans using systematic and objective procedures set by the Company.
• Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards.
• Negotiates and coordinates a prompt return to work with employer.
• Measures and reports on interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction.
• Maintains accurate record of management including costs, savings and demographic data.

Communicates effectively with all parties involved in injured worker's treatment.

• Provides case direction to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery.
• Communicates effectively with medical providers, the assigned claims examiner, injured worker and policyholder and/or handling attorneys on any given case.
• Maintains injured worker's privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards.
• Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and Providers.
• May perform Utilization Review activities (or review information coming through a vendor partner); presents reports to clients and providers .

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

Associate's or Bachelor's degree from four-year college or university in Nursing preferred. Equivalent combination of education and experience may be considered. Minimum 2 years of professional experience providing direct clinical care required.

CERTIFICATES, LICENSES, REGISTRATIONS

Current unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) required. Certification in case management, rehabilitation nursing or a related specialty is strongly preferred.

KNOWLEDGE AND SKILLS

Working knowledge in direct clinical care required. Ability to work with medical and mathematical concepts such as diagnoses, probability and statistical inference. Ability to compute mathematical frequency and percentages. Ability to apply principles of logical, sounds judgement or medical thinking to a wide range of intellectual and practical problems. Ability to combine disparate skills and thinking to craft solutions to moderate to complex problems. Ability to hypothesize on root cause of inefficiencies in treatment and then articulate probable solutions. Ability to read, analyze, and interpret documents such as medical reports and health information of all types, industry journals, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, injured workers and members of the business community. Must be able to read, write and speak English effectively. Ability to effectively present information to ICW staff, and external audiences.

PHYSICAL REQUIREMENTS

While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision. The worker is required to have visual acuity and be capable of operating and viewing computers and other electronic devices for extended periods of time.

WORK ENVIRONMENT

This position operates in an office environment and requires the frequent use of a computer, telephone, copier and other standard office equipment. Occasional travel may be required.

We are currently not offering employment sponsorship for this opportunity

#LI-ET1 #LI-Hybrid

The current range for this position is

This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

WHY JOIN ICW GROUP?
• Challenging work and the ability to make a difference
• You will have a voice and feel a sense of belonging
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
• Bonus potential for all positions
• Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
• 11 paid holidays throughout the calendar year
• Want to continue learning? We'll support you 100%

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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