NY Managed Care Specialist (Remote Worker) Job at National Interstate
National Interstate is a member of Great American Insurance Group. As one of the leading commercial transportation insurers in the nation, we offer risk financing solutions in all 50 states tailored to meet the needs of a wide variety of transportation classes. Our offerings include traditional insurance and innovative alternative risk transfer (ART) programs, including more than a dozen group captive programs catering to niche wheels markets. We are proud to be a multiple Northcoast 99 winner and Cleveland Plain Dealer Top Workplace in Northeast Ohio. It is because of our talented and dedicated team that we are able to live out our company values of integrity, transparency, fairness, accountability, empowerment and collaboration with each transaction we make. If you are ready to join an engaging and driven team such as ours, we would love to hear from you!
Responsibilities
NY Managed Care Specialist Workers Comp
- Facilitate, coordinate, monitor, and evaluate each claimant’s medical and rehabilitative treatment to ensure appropriate, effective, cost-efficient, and quality care.
- Works telephonically with claimants, employers, providers, and claim professionals to coordinate and assure proper delivery and oversight of medical services.
- Create care plans to address issues presented within the claim to enhance the claimant’s short and long-term treatment goals.
- Monitor, evaluate, and document case management activities and outcomes.
- Communicate with medical providers to track treatment progress and modify the treatment plan as necessary to achieve maximum medical improvement.
- Monitor treatment for compliance to New York Medical Treatment Guidelines and address MG-2 requests for treatment timely and appropriately.
- Manage the OnBoard Dashboard, responding to Level 1 Treatment and Formulary PAR requests. Facilitate and monitor Level 2 reviews, when needed.
- Performs other duties as assigned. Consult on claims in other venues as assigned.
Qualifications
- Bachelor’s Degree or equivalent; Must have an active, unencumbered New York Registered Nurse license.
- 5+ years of related experience, including case management, legal nurse consulting, or occupational health experience.
This job is non-exempt in California
Company:
NIC National Interstate Corporation
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