🚀 Clinic Nurse Medical Case Manager - Workers Compensation

What Is the Opportunity?

Under moderate supervision, provide office based telephonic and/or in-person medical case management supporting Concierge locations with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.

This position will work out of the Concentra Clinic in Las Vegas. Concentra Polaris, 5850 Polaris Avenue, Suite 100, Las Vegas, NV 89118. This is a unique opportunity to have face to face time while working as a case manager.

What Will You Do?

• Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan.
• Contact customer, medical provider and injured parties on claims involving medical treatment and/or disability to coordinate appropriate medical care and return to work.
• Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan.
• Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
• Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU).
• Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome.
• Utilize internal Claim Platform Systems to manage all claim activities on a timely basis.
• Utilize Preferred Provider Network per jurisdictional guidelines.
• 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.
• Customer Engagement.
• Participate in Telephonic and/or onsite File Reviews.
• Respond to inquiries - oral and written.
• Keep injured worker apprised of claim status.
• Acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Licenses are generally expected to be obtained within three months.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• RN preferred.
• Disability case management experience preferred.
• Prior clinical experience preferred.
• Familiarity with URAC standards.
• Analytical Thinking: identifies issues, analyzes information, and supports decision-making.
• Communication: clear and concise written and oral communication; ability to present file resolutions to stakeholders.
• Negotiation: ability to understand alternatives and reach agreements through discussion.
• General Insurance Contract Knowledge: understanding policies and contracts as they apply to policy conditions.
• Principles of Investigation: ability to conduct reviews to gather information about work-related incidents, injuries, treatment, and recovery factors.
• Value Determination: basic ability to assess liability and reserves.
• Legal Knowledge: basic knowledge of state, federal, and regulatory laws applicable to the insurance industry.
• Medical knowledge: understanding the nature of injuries, disability periods, and treatment needs.
• WC Technical: ability to manage treatment plans and navigate jurisdictional parameters within the assigned state.
• Customer Service: ability to build and maintain productive relationships with insureds and deliver results.
• Teamwork: ability to work collaboratively in interdependent environments.
• Planning & Organizing: ability to plan actions and contingencies to meet goals.
• Certifications: CCM, CDMS, CRC, or CRRN preferred.

What Is a Must Have?

• Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse required.

What Is in It for You?

• Health Insurance: coverage from the first day of employment for eligible family members.
• Retirement: 401(k) with company match; additional programs for student loan repayment assistance and pension eligibility.
• Paid Time Off: minimum of 20 days PTO annually, plus nine paid holidays.
• Wellness Program: resources for wellbeing, mental health support, and coaching.
• Volunteer Encouragement: Matching Gift and Volunteer Rewards program.

Employment Practices

Travelers is an equal opportunity employer. We value the unique abilities and talents each individual brings to our organization and recognize that we benefit in numerous ways from our differences.

In accordance with local law, candidates seeking employment in Colorado are not required to disclose dates of attendance at or graduation from educational institutions.

If you have questions regarding the physical requirements of this role, please contact us by email. Travelers reserves the right to fill this position at a level above or below the level included in this posting.

To learn more about our comprehensive benefit programs please visit