Catastrophic Telephonic Nurse Case Manager

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

 

Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.

 

Our field team members are located in every state in which we operate.

 

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

Essential Job Functions and Responsibilities

• Manage claims involving severe traumatic injuries, spinal cord injuries, traumatic brain injuries, amputations, severe burns, polytrauma, and other catastrophic conditions.
• Monitors, coordinates, and evaluates complex and catastrophic workers' compensation claims to ensure appropriate, effective, and cost-efficient medical care.
• Identify current and anticipated medical needs, including hospitalization, rehabilitation, durable medical equipment (DME), home health services, attendant care, and specialty treatment.
• Coordinates medical services with physicians, specialists, rehabilitation providers, hospitals, home health agencies, and ancillary vendors to facilitate continuity of care.
• Identifies barriers to recovery, treatment compliance, and return-to-work progression and develops appropriate action plans to address them.
• Serves as a clinical resource to claims professionals, employers, providers, injured workers, and other stakeholders by providing recommendations regarding medical treatment, prognosis, and disability management.
• Maintains accurate and timely documentation, clinical summaries, recommendations, and claim notes while ensuring compliance with workers' compensation regulations, nursing standards, and company policies.
• Evaluate requests for field case management and other specialized medical management services.
• Performs other duties as assigned.
• The person hired for this position will work out of the Lakeland, FL office which offers a hybrid work environment of 4 days in the office and 1 day work from home.

#LI-Hybrid 

Job Requirements

Education: Associate Degree in Nursing required. Bachelor of Science in Nursing (BSN) preferred. Current unrestricted Registered Nurse (RN) license required; Compact RN licensure preferred.

Experience: Minimum of 5 years of direct clinical nursing experience required, preferably in acute care, trauma, critical care, rehabilitation, or a related specialty. Preferred 3-5 years of catastrophic workers' compensation case management experience with a demonstrated ability to manage complex, high-exposure claims from initial referral through claim resolution. Experience navigating workers' compensation regulations, medical management practices, treatment guidelines, utilization review processes, and return-to-work programs across multiple state jurisdictions is strongly preferred.

Scope of Job/Qualifications: Extensive knowledge of workers' compensation medical management principles, evidence-based treatment guidelines, and disability management practices. Strong ability to assess complex medical conditions, analyze medical records, identify barriers to recovery, and develop effective case management strategies. Excellent organizational, written, verbal, and interpersonal communication skills. Ability to collaborate with multidisciplinary teams and manage multiple priorities while maintaining confidentiality. Demonstrated proficiency with claims management systems, electronic medical records, and Microsoft Office applications. Viewed as a clinical resource for complex and catastrophic claims management.

Work Arrangement: This position may be structured as either a hybrid or fully remote role. Hybrid work arrangements are available for internal and external candidates. A fully remote work arrangement may be considered for highly qualified external candidates who demonstrate extensive experience in catastrophic workers' compensation case management, proven success managing complex claims independently, and the ability to effectively collaborate and achieve outcomes in a remote work environment. Final work arrangement will be determined based on qualifications, experience, and business needs

Preferred Certifications: Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Registered Nurse (CRRN), or equivalent case management certification.

Company:

SCI Summit Consulting, LLC

Benefits:

We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

 

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

 

*Excludes seasonal employees and interns.