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Workers Compensation Nurse Consultant

Employer
Chubb
Location
Los Angeles, CA
Closing date
May 14, 2021

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Profession
Nurse
Specialty
Medical Management
BASIC FUNCTION OF THE JOB:

TheNurse Consultantis an integral member of the Workers Compensation Claims unit and is responsible for the oversight of the medical management program within the assigned service and location areas.This position is located in our Los Angeles, CA office. The key functions of the job include:

Managing a team of Telephonic Case Managers handling CA, AZ, CO and UT assignments;
Participating in the recruiting and hiring process;
Onboarding of new hires and ongoing training to ensure employees are aware of medical and disability management processes, goals and related workflows;
Collaborating with the leadership team to provideongoing education and training for the claims staff on all aspects of medical claim management; and
Participating in special projects or other initiatives to further the strategic priorities of the medical management team.

The Nurse Consultant responsibilities also include utilizing triage criteria for TCM, FCM and MMS referrals, providing appropriate oversight of the external case management providers, providing insight on medical treatment costs as well as procedures, overseeing vendor management and evaluating the appropriateness of treatment and costs to assist adjusters with overall claim exposure.The Nurse Consultant provides catastrophic case management oversight and direction for severe claims.

Other key functions of the role of the Nurse Consultant include the implementation of Chubbs managed care program for insureds, coordinating the development of medical panels as appropriate, monitoring managed care regulations and staying current on medical trends. The Nurse Consultant partners with Underwriting and Claim Business Consultants to market Chubbs managed care program to existing and prospective accounts. The Nurse Consultant maintains ongoing communication with the claim and underwriting staff and serves as a liaison to assist with oversight of the managed care program for insureds.

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