General Description: Manage medical activities of workers compensation and disability claims for Third Party Administration (TPA) accounts. Coordinate with patients, physicians, other health care providers and employers. Facilitate positive patient outcomes, timely return to work, and efficient claims resolution.

Responsibilities:

Manage activities of workers compensation and disability claims, case management, and utilization review. Ensure compliance with established policies and procedures and applicable legal and regulatory guidelines.
Manage ongoing managed care activities. Includes case management of medical aspects of workers compensation and disability claims for TPA accounts.
Coordinate with patients, physicians, health care providers, and employers to facilitate positive patient outcomes, timely return to work, and efficient claims resolution and utilization review.
Gather demographic and clinical information on inpatient admissions and outpatient treatment.
Certify the medical necessity of services. Assign appropriate length of stay and treatment plans.
Present case management and utilization review information to prospects and clients.
Assist adjuster with complex medical aspects as necessary. Resolve escalated issues and problems by conferring with staff, management, other internal departments, outside contacts, and clients.
Perform case management and other activities as workload requires. Respond to requests from insurance carriers, medical personnel, attorneys, etc.
Assess internal and external customer needs. Manage activities to ensure services are delivered efficiently.
Evaluate and update treatment and return to work plans within established protocols.
Communicate with internal teams and management on account information and status updates.
Maintain knowledge of current developments in the managed care industry. Includes regulatory issues and guidelines changes.

Knowledge, Skills and Abilities:

Registered Nurse (RN) from accredited college. Must have an active state license and eligible to obtain additional state licenses.
5 to 10 years workers' compensation and disability case management experience required.
Masters degree in business, healthcare or other related field preferred.
CCM, CRS or CDMS certification required.
Excellent understanding of managed care industry practices. Includes medical case management, utilization review, and related legal and regulatory guidelines.
Strong clinical background in orthopedics, neurology or rehabilitation.
Highly organized, with ability to manage work involving large client volume.
Strong understanding of managed care technology applications.
Excellent verbal and written communication skills.
Ability to work well in a team environment.
Must have strong analytical thinking and problem-solving skills.

Physical Demands:

Work is performed in a climate controlled office environment with minimal noise and limited to no exposure to chemicals or toxins. Employees operate office equipment including telephone - headset, computer, computer monitors, keyboard, mouse, copier, scanner, and mail machine. Physical tasks of job include walking, sitting, standing, and bending.

Analysis of Physical Demands:

Constantly (over 66% of time) work performed requires employees to use repetitive hand motions such as typing, using a keyboard, and sitting at a desk.
Frequently (34%-66% of time) work performed requires employees to handle and grasp things, walk on normal surfaces, stand, and bend.
Occasionally (1%-33% of time) work performed requires employees to drive to client appointments, have repetitive foot movements, walk on uneven or slippery surfaces to and from work and occasionally reach outward to grab things and bend.
Rarely (< than 1 hour per week) work performed requires lifting/carrying items that range from 10-50lbs, pushing/pulling items that range from 10-50lbs, twisting/turning including reaching over shoulder or above head, kneeling or squatting.

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Why USI?

With more than $2.7 billion in revenue and over 10,000 associates across approximately 200 offices nationwide, USI is one of the largest insurance brokerage and consulting firms in the world. At USI, we have created one of the most dynamic personal and professional development cultures in the industry. We invest heavily in our associates, and we take pride in celebrating their growth and success through our one-of-a-kind employee reward and recognition programs.

Unrivaled Resources and Support

What truly distinguishes USI as a premier insurance brokerage and consulting firm is the USI ONE Advantage®, a game-changing value proposition that delivers to clients a robust set of risk management and benefit solutions with bottom-line financial impact. USI ONE® represents Omni, Network, Enterprise-the three key elements that set USI apart from the competition. Through USI ONE, we develop strategic, timely, and effective risk management and benefit programs in terms that are easy to understand, and we demonstrate how the solutions can have a positive economic impact.

Industry-Leading Programs, Rewards, and Recognition

In addition to competitive pay, incentives, and benefits, USI recognizes associates through our Summit Awards program, rewarding excellence in those who build our brand each day. USI offers employee programs that recognize outstanding achievement and help our associates lead healthy, productive lives. We turn care into action with our award-winning wellness program, college scholarships for associates' children, and financial help in times of need.

Deep Community Engagement

We are committed to giving back to our local communities and supporting a culture of environmental sustainability. From sharing our time, talent, and resources to support local non-profit organizations, animal shelters, and environmental beautification and restoration projects - to partnering with eco-conscious vendors and taking steps to reduce our own environmental footprint - we're working together as ONE to build a better future.

Committed to a Diverse, Equitable, and Inclusive Workplace

Our award-winning I'm With U diversity, equity, and inclusion program educates our associates to help them better understand and serve our clients, prospects, fellow team members, and local communities through curated education and training resources, employee support programs, and community outreach initiatives to build a more diverse, equitable, and inclusive culture.

Nationally Recognized as a Top Insurance Employer

Recognized as one of Insurance Business America's Top Insurance Employers for the seventh consecutive year (2018-2024).
Named to Business Insurance's annual list of the Best Places to Work in Insurance five years in a row (2020-2024).
Named to Fortune's 2024 Best Workplaces in Financial Services & Insurance list.
Honored by Glassdoor as a Best-Led Company in the U.S. in 2024.
Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024

Visit our Awards and Accolades page for a complete list of our latest industry awards and recognitions!

USI is committed to providing a full-suite of competitive benefits for our growing population and its diverse needs. We offer a wide range of health, welfare and financial benefits including medical, wellness, dental and vision, 401(k), flexible spending and health savings accounts, short and long-term disability, life insurance and other unique employer-sponsored and voluntary programs. USI also offers a generous paid time off policy, paid family leave benefit as well as paid holiday time.

$80,000 - $102,000

Job ID:

29943

USI Holdings Corporation

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TPA Medical Case Manager