Nurse Case Manager
About the Job
Employers count on The Standard (www.standard-ny.com) to meet their employees’ needs for group life, disability and dental insurance products and services. But they also know we go beyond simply meeting needs. We help people achieve financial well-being and peace of mind. If you want to make a positive difference for customers, consider pursuing your career dreams with us.
Assess claimants’ medical conditions, diagnostics, procedures performed and ongoing treatment to determine functional capacity levels as well as the appropriateness of care. Collaborate with treating physicians to promote suitable care plans directed toward return to work by communicating with claimants, treating and consulting physicians, employers and benefits personnel. Assess medical record documentation for completeness. Coordinate claim prevention, intervention and return to work programs for employers.
Contribute to the company’s success through excellent customer service and meeting or exceeding performance objectives for the following major job functions:
- Evaluate medical history and treatment and test results during file reviews and consultations with division benefits staff. Provide assessments of claimants' functional capacity and their levels and expected durations of impairment. Identify and resolve stated limitations inconsistent with medical documentation. Assess medical records to determine if claim for disability is caused or contributed to by a limited or excluded medical condition.
- Assess adequacy and appropriateness of treatment. Advocate on behalf of the claimant for appropriate services and treatment to attain maximum medical improvement and successful return to work. Work in conjunction with vocational and benefits staff to assess claimants' psychosocial, environmental and financial status. Communicate with claimants, their families, employers, medical treatment providers, rehabilitation counselors and other carriers such as workers’ compensation providers or HMO’s, to ensure understanding of and cooperation with the recommended treatment plans and the goal of returning to work.
- Provide claim prevention services by working with employers to evaluate their organizations' trends in disabilities. Coordinate site visits and assessments; advise on educational programs for employee groups; work in conjunction with vocational staff to recommend job site modifications and safety or procedural changes. Collaborate with sales, underwriting, and vocational and benefits staff to recommend, develop and implement intervention and return to work programs and practices for employers.
- Develop and conduct medical education and training for division claims personnel.
Demonstrated skills: Effective case management. Effective identification and resolution of problems. Clear and persuasive expression of ideas in both written and oral communications. Effective collaboration with peers and team members.
Ability to: Utilize computer software and hardware applications. Talk by telephone. Shift priorities to meet demands from various customer groups. Make decisions in the absence of specific direction. Facilitate group discussions. Achieve professional designation.
Working knowledge of: Assistive devices needed by people with disabilities. The Americans with Disabilities Act, family leave laws, Fair Claims Settlement Practices Act, and laws governing client confidentiality.
Education: BS or MS in a related field.
Experience: A minimum of 4 years hospital or clinical experience in relevant medical fields (e.g. cardiology, orthopedics, mental health) or utilization review or quality management, or the equivalent combination of education and/or relevant experience.
Professional certification required: Current Registered Nursing license, with a CCM or CPDM designation or ability to obtain such a designation within 2 years of hire.
Standard Insurance Company, The Standard Life Insurance Company of New York, Standard Retirement Services, Inc., StanCorp Equities, Inc. and StanCorp Investment Advisers, Inc., marketed as The Standard, are Affirmative Action/Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, gender, sexual orientation, age, disability, or veteran status or any other condition protected by federal, state or local law. The Standard offers a drug and alcohol free work environment where possession, manufacture, transfer, offer, use of or being impaired by an illegal substance while on Standard property, or in other cases which the company believes might affect operations, safety or reputation of the company is prohibited. The Standard requires a criminal background investigation, drug test, employment, education and licensing verification as a condition of employment. All employees of The Standard must be bondable.
For more information regarding your Equal Employment Opportunity applicant rights, click here.
Individuals with disabilities who need assistance or accommodation with the application process should contact HR Direct at 971-321-7871. This number is only for the use of individuals with disabilities who need accommodation with the application process. General inquiries about application status will not be addressed.