Case Manager/Utilization Review Nurse
Current- Formulates new workflows for nurse case management referrals for new and existing worker's compensation claims.- Provides claim direction to assist claimants in reaching MMI.- Performs claim reviews to identify areas of care that need intervention and compensability - Performs utilization reviews for medical necessity for various medications, surgical treatments, DME, etc. for numerous states.- Works with vendors in assisting care for claimants.- Works collaboratively with claims adjustors to guiding care that is efficient and within the claimant's best interests toward a path of healing and returning to work.- Communicates with claimants, attorneys, adjusters, legal teams, physician offices and other facilities to deliver quality care efficiently while being cost effective.- Interviews nurses to be a part of worker's compensation nursing team.- Creates education materials for company process and internal systems