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Job Location: |
Triangle |
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Job Title: |
Case
Management Specialist |
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Job Description: |
The
Redwoods Group is a socially conscious organization that provides highly
specialized insurance underwriting, risk management and claims handling focus
for two distinct non- profit child serving organizations: YMCAs and Jewish
Community Organizations. We offer
insightful, intimate and expert risk management as well as insurance products
and services that meet our client’s specific needs. We are a company with a long-term commitment
to our clients, a commitment that is returned in the form of consistent
renewal retention in excess of 95%. We
seek to learn as much as we can about each customer group’s business and
operations so that we do a better job of protecting the communities we serve. The
Redwoods Group is a dynamic organization driven by our non-traditional, but
sustainable, business model, our people and our unique product/service value
proposition. Our culture is as unique: we foster a productive team spirit
that is born out of respect and is maintained by a broadly shared commitment
to our mission. Redwoods is a truly rewarding place
to work because of our mission, business model and surprisingly talented and
experienced staff. We treasure diversity in the workplace, and provide a
supportive environment for all employees. We believe in making a difference
in the world and strive to serve the communities in which we live and work. If
you’re a registered nurse looking for a new opportunity to work in a
fast-paced, professional environment The Redwoods Group has the opportunity
for you. This position requires collaborating with risk management and
underwriting, claimants, customers, employers, and claims professionals by
providing nurse case management services for workers compensation claims. We
are currently seeking a Case Management Specialist to work with our YMCA
& JCO program teams in our Responsibilities
will include: • Ensure delivery of the “ • Early invention on all WC claims, with
particular emphasis on lost time cases. • Medical and disability case management
oversight of TPA/carrier, which includes review and evaluation of workers’
compensation claims for vocational and/or medical service delivery. • Liaison between the TPA/carrier, the
YMCA and the injured worker. • Assess, monitor and evaluate medical
services, disability management and modified duty/return to work options. • Collaborate with risk management and
underwriting on safety and return to work programs, and exposure/loss issues. Duties
include: • Triage the FNOL call from the YMCA o Provide any initial guidance needed to
the YMCA o Refer call to TPA/carrier FNOL call
center • On lost time cases o Make initial contact with the injured
employee and theYMCA o Provide initial advice to the injured
employee and explain the workers’ compensation claim handling process • Review all new “medical only” losses
and monitor medical service delivery • Make initial employee contact on
injuries • Obtain and document coverage
information and forward to TPA/carrier • Provide guidance to the Y in the claims process • Review and monitor TPA/carrier claims
files ongoing to ensure all injured workers are on an aggressive treatment
plan and that modified duty/RTW initiatives are being utilized. • Maintain diaries on lost time cases
and medical only cases, as appropriate. • Collaborate with TPA/carrier and offer
input and suggestions where appropriate. • Analyze losses and track trends, work
closely with Risk Management on safety issues. • Evaluate RTW programs and identify
risk management, underwriting or other issues that need to be addressed
within Redwoods. • Monitor TPA quality and contract
compliance with regard to managed care initiatives. We
are looking for a Registered nurse with 3-5 years clinical practice
experience, along with 2-3 years workers’ compensation case management or
utilization review experience. Excellent verbal and written communication
skills are required. Strong interpersonal
and customer service skills are needed. Proficiency with Microsoft Office
(i.e. Outlook, Word, Excel) and technical workers’
compensation claim handling experience preferred. Experience with child
serving organizations is a plus.
Bilingual a plus Prior supervisory experience is also a plus.
Interested candidates will send a cover letter and resume to
careers@redwoodsgroup.com. |
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Contact Name: |
Erin
Garney |
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Agency/Company: |
The
Redwoods Group |
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Address: |
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Phone: |
919-462-9730 |
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Fax: |
919-287-2350 |
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Email: |
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Job Number: |
1721 |
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Date Posted: |
6/3/08 |