CSC Nurse Case Manager

Chubb Group of Insurance Companies has an exciting opportunity for a CSC Nurse Case Manager within their Simsbury, CT office.

Underwriting: Review large claim information from prospects to evaluate and assist the team with making sound underwriting decisions based on medical judgment and the use of clinical evidenced based literature/guidelines.

Claims: To evaluate and recommend appropriate, cost effective medical treatment of employees with the goal of optimum medical improvement.

Major Duties/Responsibilities of Position

Underwriting

Review claim information from prospects at the underwriter’s request.
Obtain additional medical information from TPAs, NB & Renewal.
Collaborate with Physician Consultants to assess potential risks for specific period of time.
Develop protocols and guidelines for use of physician consultants/outside resources.
Act as a medical resource to the underwriting team in order to address disclosures.

Claims

Establish templates/guidelines for dialog with TPA’s.
Formulate current vendor list, including additional medical resources by specialty.
As part of early intervention program, triage 50% notices to determine need for nurse consulting services. Assist with fee negotiations with large medical facilities whenever possible ie. Request for advance funding.
Evaluate need for independent examinations.
Work closely with the claim representatives and bill reviewers to ensure payments by the TPA’s were made appropriately and Chubb reimbursements are accurate and timely.
Collaborate with claim representatives to identify cases that may have potential for additional discounts through alternative PPO and specialty networks.
Offer recommendations to the TPA to insure adequate case management is being provided.

Knowledge & Skills (education, experience, etc., and the application of these on the job):

- Bachelor of Science in nursing preferred. Registered nurse certification will also be accepted. CCM certification or eligibility (Certified Case Manager) required . CDMS (Certified Disability Management Specialist) and/or CRRN (Certified Rehabilitation Registered Nurse) may be considered, depending upon experience, training, and knowledge. Minimum of three years experience in the medical management field required.

- Excellent communication skills mandatory; this position will involve continuous personal, telephone, and written contact, and appropriate interpersonal skills are critical.

- Must have knowledge of complex traumatic injuries and other medical conditions related to the Group Health Insurance industry.

- Ability to work independently, and yet dependably meet deadlines. Time management and personal organization skills required.

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