SFM is seeking a Director of Nurse Case Management to provide technical oversight, training and direction to the nurse case managers that support the claims department. You will work collaboratively with key stakeholders within the organization providing direction concerning medical case management related to workers' compensation claims. SFM offers a robust benefit package that includes all the perks you need to navigate your work-life journey. SFM believes that our exceptional and motivated employees are our greatest strength, and we are committed to creating the best work environment.
Salary Range: $102,655 to $153,982 per year
The Director of Nurse Case Management will provide technical oversight, medical expertise, mentoring and education to the Nurse Case Managers as well as assist claims staff with the direction of medical care related to work comp injuries. At SFM, our mission is to do the right thing and support the injured worker while they recover from a work related accident. You will follow best practices in the application of case management, medical management policies and procedures related to workers' compensation claims. Working collaboratively within multi-disciplinary teams is key in this role and possess a desire to deliver the best outcome for all parties. You will strive to bring successful resolutions to medical issues and provide mentoring to various internal business partners while delivering high-quality medical management and guidance to all parties.
This is a hybrid role, and living in Minnesota is needed as some in office time is needed.
Our benefits include:
Affordable Medical, Dental, Vision Insurance, HSA, FSA Flexible hybrid work environment Traditional and Roth 401(k) plans with company match Company contributions to help pay off student loans Monthly home internet allowance Free life insurance, STD & LTD Opportunities for annual gainshare bonus Pet insurance Generous PTO 9 paid holidays Paid parental leave Annual company-wide volunteer day Discounts on gym memberships, fitness apps and weight loss programs Adoption financial assistance
What You Will Be Doing
Management and Utilization Review:
Responsible for strategically leading and managing Nurse Case Managers (NCMs) by establishing case management best practices and NCM technical oversight to achieve corporate goals. Establishes, modifies and documents NCM practices and procedures, and communicates these best practices to management and NCMs. Communicates timely prescription medication, medical treatment and durable medical equipment recommendations relative to workers' compensation files to claims, NCM and legal after performing a medical records review and assessment. Documents recommendations/plan and prepares appropriate correspondence when needed. Consults with key stakeholders within the organization. Provides education, mentoring and medical treatment parameter information and/or guidelines regarding use of treatment modalities and medication usage in collaboration with internal leadership. Uses medical guidelines and protocols as established by SFM, state, and/or national guidelines (ODG, FDA, MDA, MN Board of Medical Practice, state specific workers' compensation boards, pharmacy benefit management reports). Participates in pharmacy benefit management calls with internal stakeholders and makes recommendations for opportunities for improvement in their reports, communication, etc. Participates in round tables and claim reviews internally as well as with WCRA. Monitors prescription usage for appropriateness and cost containment and schedules drug review meetings as needed with internal stake holders.
Business Operations
Provides quality review of NCMs related to application of medical management practices and procedures through the use of internal audits and other appropriate methods. Accountable for quality management of NCMs. In coordination with Strategic Business Unit (SBU) leaders assists as needed with interviewing, training and onboarding new NCMs. Partners with internal stakeholders and Human Resources, determining the need for and delivery of technical training and follows up to ensure that individuals have achieved a successful outcome. Works with SBUS and Business Services to enhance/develop training materials and programs to increase technical knowledge of all staff members and identifies areas of opportunities. Applies business unit policies, best practices and procedures. Leads by example showing professionalism to internal and external customers and maintains a high level of professionalism when working with all r team members ensuring a high level of customer service. Provides premier customer service to all customers and complies with customer service standards and adheres to partnership agreements with business service teams. Responds promptly to resolve complaints or problems and manages escalated matters with little direction. Shares thoughts and ideas in team meetings and encourages others to do the same. Demonstrates positive behavior and promotes positive attitude among team members. Pushes team members to perform at a high level. Regularly interacts with team members, injured workers, policyholders, physicians, and technical specialist and rehabilitation consultants to achieve individual and team goals. Maintains appropriate interactions with persons both within the organization and externally and serves as backup to leader when needed. Identifies and communicates trending and prescription drug and medical case management practices that could impact the team's book of business.
What We'll Love About You
Bachelor's degree in in nursing, healthcare and/or insurance related field. Eight or more years' experience in healthcare, utilization review, insurance and/or medical management of workers' compensation claims. RN credentials in core states as well as medication review experience preferred Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS) or Certified Rehabilitation Registered Nurse (CRRN) designations preferred.
Knowledge and Skills:
Strong understanding of workers' compensation claims handling. Excellent decision making and negotiation skills. Able to navigate difficult conversations effectively and professionally. Driven to create a culture of continuous improvement and innovation. Strong, practical problem-solving and decision-making skills. Excellent communication and presentation skills, both written and verbal. Exceptional customer service skills. Must be willing to come into the office as needed. Ability to establish effective relationships. Demonstrates an understanding and willingness to learn the various fundamentals of insurance finance. Proficient in using current technology and in adopting new technologies to enhance job performance and service delivery. Experience using analytics tools and techniques to evaluate performance metrics, identify trends, and make data-driven decisions. Strong analytical skills and ability to sort through information quickly and effectively. Strong knowledge of prescription medicine protocols and physician advisor utilization. Effective organizational skills including the ability to manage multiple projects and work with minimal direction. Proficient in MS Office software applications (Excel, Word, etc.).
Physical Requirements
Regular attendance is required. Work takes place in a semi paperless environment within an office setting, either on business premises or other remote location, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The base pay posted is just one component of SFM's total compensation package. The salary range listed represents the full compensation range for this position. Job title and starting pay will be based on the selected candidate's relevant knowledge, skills, abilities and/or experience, and education, if applicable as well as internal equity with other employees in the same job classification.
About SFM
Since 1983, our mission has been to be the workers' compensation partner of choice for agents, employers and their workers. In that time, we've expanded to over 30,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, loss prevention, medical services and more.
SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey.
SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, marital, familial, or veteran status, medical condition or disability, or any other legally protected classification.
SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.
