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Workers' Compensation Nurse Case Manager
- New York, New York, United States
- New York, New York, United States
À propos
What You will Do Early intervention for medical case management on select workers' compensation claims: Manage and process Prior Authorization Requests, also known as PARs, submitted by the treating providers through the OnBoard system. Provide case management in a workers' compensation environment. Document assessment and care plan of the IW to collect information needed to formulate a claim plan collaboratively. Develop appropriate treatment plans with a balance between quality of care and cost-effectiveness that meets a universally accepted medical and disability duration guideline. (ODG/Presley Reed) Adhere to URAC (Utilization Review Accreditation Commission) standards. Certification preferred but not required. Provide appropriate Utilization and Review of treatment under the NYS Medical Treatment Guidelines and recommend approval or denial to claims adjusters based on medical documentation, the guideline(s), and nursing Standards of Care. Collaborate with members of the Claims Team and Nursing Team. Participate in file reviews and roundtables on complex and catastrophic cases. Provide documentation that is clear, concise, and reflects strong technical and clinical knowledge with nursing assessments and action plans. Provide effective vendor management when assessing or managing cases. Serve as an informational and medical resource for the Claims Management staff. Provide claim review services on cases as needed, as per BCF policy and procedure. What You Bring You are a nursing professional who thrives in a demanding environment and knows how to balance medical expertise with sound judgment. Required: Candidate must present documentation to verify the minimum school educational requirement. Candidates are subject to a 90-day evaluation period. Experience / Certifications / Skills: An associate or bachelor's degree in nursing required; Registered Professional Nurse in NYS required Five or more years of clinical nursing experience are preferred. CCM (Certified Case Manager) or COHN (Certified Occupational Health Nurse) preferred but not necessary. Candidates without either a CCM or COHN must confirm their intent to work toward certification. URAC standards understanding and/or certification preferred. Demonstrate completion of the NYS Workers' Compensation Medical Treatment Guideline online training. Knowledge of New York workers' compensation, disability, and managed care law is preferred. Customer Focus: provides outstanding customer service, listens, and maintains composure in all situations and involves others when appropriate; interpersonal/savvy - relates well with people with diverse backgrounds and can build appropriate rapport.
Composure: Is cool under pressure; does not become defensive or irritated in tough situations. Effective communication: Communication style that adjusts delivery to reach different audiences; strong verbal (phone) and written communication skills; ability to deliver difficult information, plus excellent decision-making and critical thinking skills. Multi-tasking: Ability to adapt to changing priorities while maintaining a positive attitude. Time Management: Ability to coordinate services, tasks, and reports promptly. Proficient in current Microsoft Office Suite programs
Medical specialties: Critical & Intensive Care Medical-Surgical Occupational Medicine Physical & Rehabilitation Medicine Primary Care Surgery
If you are looking for a role where your expertise is truly valued and where flexibility, purpose, and professional growth come together, we would love to hear from you. Why You Will Love Working with Us: We are committed to creating a supportive, rewarding, diverse environment where your contributions truly matter. Here is what you can expect as a member of our team: Competitive Salary: $105,000 - $115,000 per year. Generous Benefits: Health Care Benefits with limited employee contribution. One of our health plans requires no contribution. All plans cover eligible family members at similar rates. 401(k) with 100% employer match (up to 6% of salary). ROTH 401(k) 100% employer-paid Life Insurance, Dental, and Vision coverage. Paid Vacation & Sick Time, plus Pre-tax Transit Benefits. Flexible Spending Account allows you to use pre-tax monies to pay unreimbursed medical and dependent care expenses. Lifestyle Spending Account allows you to use pre-tax monies for expenses incurred in a wide variety of categories, including sports equipment, utility bills, and auto expenses. Pet Discount Program covers any pet, regardless of breed, health, or age! Employee Assistance Plan available on a confidential basis. $2500 Signing Bonus to welcome you to the team! Work-Life Balance: Hybrid (for residents) work schedule after training. Team-Oriented Culture: We foster a collaborative environment with opportunities for growth through team-building exercises and training. Career Growth Opportunities: The Black Car Fund supports your professional development through ongoing education and skills training. Qualifications & Requirements: Education: BSN preferred; associate or bachelor's degree in nursing required. A New York State nursing license is required. Experience: 5+ years of experience as a Nurse Case Manager or relevant practical experience. Location: Hybrid or Remote position. For those who live within 75 miles of Long Island City, a hybrid work schedule is offered. If you live more than 75 miles from Long Island City, a remote work schedule is offered.
Who Should Apply: The Black Car Fund is an equal-opportunity employer, and we strongly encourage qualified military veterans and spouses to apply. We value diversity and are committed to creating an inclusive work environment where everyone can thrive. If you're ready to bring your skills, enthusiasm, and passion to a meaningful role, apply now to join our team at The Black Car Fund, one of the Top Places to Work in New York by City & State New York, and named one of the Best Companies to Work For in New York in 2026 by Best Companies Group!
Compétences linguistiques
- English
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