| Job Description | Vanliner Insurance Company is a subsidiary of National Interstate Insurance Company (NASDAQ: NATL) and leading provider of transportation insurance. We’ve been providing customized insurance products to the moving and storage industry since 1978. Our success is driven by the expertise, innovation and commitment to customer service our employees provide. Vanliner Insurance is headquartered in Fenton, Missouri, a suburb of St. Louis.
The primary responsibility of Claims Nurse Consultant is to serve as the medical technical resource for the Workers’ Compensation Claims Staff.
Responsibilities:
Review requests for Utilization Reviews and when approved, send the appropriate records and documentation for UR request to the state. Based on jurisdiction and type of injury, conduct the utilization review as permitted.
Review Requests for Approval of treatment from medical providers or from claim representatives, which includes evaluating the medical treatment to determine whether it was/is reasonable, necessary and causally related.
Directly manage Nurse Case Management Vendors assigned to claims.
Interpret routine, complex or unique medical information.
Discuss medical information with claim handler to assist with plan to proactively manage the injury exposure.
Identify areas of opportunity for training which include, emerging medical trends, complex injuries, high frequency injuries and other medical topics. The Audience may include claim, loss control, underwriting or external customers.
Discuss treatment with Medical Providers where concerns arise regarding necessity of treatment.
Assist the claim handler in projecting medical costs.
Provide medical expertise by attending mediations, arbitrations, pre-trial conferences, depositions and trials with claim staff on an as-needed basis.
Maintain documentation in the claim system and keep accurate records.
Assist the liability unit as a medical consultant as needed.
Participate as the medical expert during Large Loss and other roundtable sessions.
Assist with internal auditing of files where expertise is warranted.
Perform other duties as assigned.
Qualifications
Registered Nurse or equivalent; as well as appropriate license per state regulation.
Certified Legal Nurse Consultant desirable, but not required.
Strong clinical background.
Knowledge of jurisdiction-specific medical guidelines desirable.
Strong knowledge of medical causation and relatedness.
Strong knowledge of medical treatment standards of care.
Strong research and analytical thinking skills.
Effective time management and organizational skills.
Insurance Company or experience working in the workers' compensation industry a plus.
Working knowledge of Microsoft Word, Excel, and Outlook and the ability to learn PowerPoint.
Travel Requirements: 0-10%
DS |
| | Company | | Vanliner Insurance Company | Job Code | | State or Province | | Missouri | | |
|
