Nurse Case Manager

SFM Companies (SFM Mutual Insurance)
September 12, 2023
Des Moines, IA
Job Type


Working remotely in Iowa, the Nurse Case manager serves as a medical resource and educator to assist with the management of workers' compensation claims. You will help injured employees find the best medical care, and work with claims staff guiding the medical aspect of the claim. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. Our employee's provide the highest level of customer service and help maintain SFM's position as a leader in the WC Insurance Industry.

As a Nurse Case Manager, you will work collaboratively within a multi-disciplinary Strategic Business Unit (SBU) providing medical expertise to bring medical and claim issues to an expedient and cost-effective resolution. You will work telephonically to deliver high-quality services to injured workers and policyholders, which will involve the medical management of a WC claim and return-to-work aspects of workers' compensation claims. In this role, the Nurse Case Manager seeks to continuously promote effective medical case management following medical best practices guidelines and state laws and regulations in partnership with claims reps. This position requires you to live in Iowa, and persons with occupational health experience are encouraged to apply.

The ideal candidate will live in or near the Des Moines, IA area.

What You Will Be Doing

  • Provides telephonic medical case management relative to workers' compensation files; performs an assessment, develops a plan, and coordinates services to facilitate return to work and achieve optimal end of healing result (EOH) or maximum medical improvement (MMI)_ in a timely, quality, and cost-efficient manner. Duties may necessitate contacting or meeting with employees, employer customers, physicians and other medical professionals to affect the best outcomes.
  • Responds to email referrals in a timely manner pursuant to the SFM best Reviews the claim file, makes initial contacts to the injured worker, policyholder, physician provider, and claims team members within 24-48 hours upon referral.
  • Delivers exceptional customer service by providing ongoing communication via telephone, email to internal and external customers or in-person visits as noted in the plan and upon receipt of new information in a timely manner to ensure delivery of medical recommendations and return-to-work options. Attends employer meetings with SBU team members as deemed appropriate.
  • Utilizes effective and proactive return-to-work strategies by working with providers and policyholders to establish a plan using guidelines, medical data, resources, and functional abilities of an injured worker. Identifies light-duty work available and shares job descriptions with medical providers, etc.
  • Provides education and medical treatment parameter information regarding general healing, injury specific health information, and disability duration to internal and external customers to facilitate medical recovery, function and return to work. Resources may include discussions with physicians, general research via the Internet, treatment guidelines, and any other in-house resources provided by the company (i.e., PA,). Uses medical guidelines and protocols as established by SFM, state, and/or national guidelines (i.e. Official Disabilities Guideline and/or MD Guidelines) Resources may include discussions with physicians, general research via the Internet, intranet, treatment guidelines, and any other in-house resources provided by the company. Uses medical guidelines and protocols as established by SFM, state, and/or national guidelines (i.e. ODG and/or MDA).
  • Assists claims team members to determine if medical treatment recommendations are reasonable, necessary and timely with coordination of physician advisors (PA). Provides information to assist claims team members to formulate accurate plans using company resources, treatment guidelines, etc. Coordinates discharge planning, DME and home health care needs.
  • Makes recommendations to the claims rep resources to assist with medical, cost-containment and return-to-work issues (i.e., PA, second opinions, IME, ergonomic evaluations, job analysis, etc.). May attend in-house physician advisor, roundtables and med/legal sessions as needed either telephonically or in person.
  • Documents timely initial and ongoing assessment plans in the claims file to keep internal customers apprised of medical case management and return-to-work progress.
  • Collaborates with claims team members on timely closure of the files that are managed by the Nurse Case Manager.

What We'll Love About You

  • Associate's Degree (Bachelor's Degree Preferred) with current RN licensure in the state hired; multi-state licensure preferred.
  • Two years of relevant experience such as, Case Management, Physical Rehabilitation, or Occupational Health.
  • Worker's Compensation or casualty insurance experience preferred.
  • Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS) or Certified Rehabilitation Registered Nurse (CRRN) designations preferred.
  • Five years of clinical experience preferred.
  • Ability to evaluate ongoing treatment and return-to-work potential within established protocols and make adjustments to case management strategies as warranted.
  • Strong knowledge of medical treatment protocols and physician advisor utilization
  • Effective organizational skills including the ability to manage multiple projects and work with minimal direction.
  • Demonstrates positive teaming skills focused on team results and builds strong partnerships with internal customers.
  • Excellent customer service and interpersonal skills.
  • Exceptional verbal communication skills with the ability to work with a diverse group of people.
  • Excellent customer service skills, and the ability to work well within a team environment.
  • Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed.
  • Excellent documentation writing skills and ability to assimilate information from a variety of sources.
  • Independent and sound judgment with good problem solving skills.
  • Proficient in MS Office software applications (Excel, Word, etc.).

Physical Requirements

Regular attendance is required. Work takes place in a semi paperless environment within an office setting, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions. Travel as needed.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

About SFM

Since 1983, our mission has been to be the workers' compensation partner of choice for agents, employers and their workers. In that time, we've expanded to over 30,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, loss prevention, medical services and more.

SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey.

SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, marital, familial, or veteran status, medical condition or disability, or any other legally protected classification.

SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.

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