Nurse Case Manager ,Workers Compensation

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™. Company Mission: Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners. Company Vision: Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work. Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines. Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process. Proven ability to anticipate claimant's treatment or recovery milestones. Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives. Facilitates and expedites discharge planning as needed. Produces accurate electronic records of individual cases. Ensures timely, cost-effective medical care for injured workers' recovery. Answers provider calls and assists with Casualty Department workload as necessary. Adheres to established quality assurance standards and MagnaCare policies and procedures.