AmTrust Financial Services, Inc. · 4 hours ago
Major Case Manager
Dallas, TX, US
Full-time
Hybrid
Mid, Senior Level
$88K/yr - $107K/yr
5+ years expAmTrust Financial Services is a fast growing commercial insurance company, and they are seeking a Complex Care Case Manager, RN for their Workers Compensation managed care team. The role involves providing comprehensive telephonic case management for injured employees with complex diagnoses, ensuring they receive appropriate healthcare and support for their recovery.
FinanceFinancial ServicesInsurance
Responsibilities
Uses clinical/nursing expertise to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered
Improve the quality of life with the overall goal of return to pre-injury status. Assist the injured employee and family to secure optimal care and achieve full recovery
Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines
Coordination of medically appropriate care where multiple services may be needed such as discharge planning for hospitalizations, pain and symptom management, home health, provider home visits, home based palliative care or assistance with daily living activities
Responsible for accurate comprehensive documentation of case management activities in case management system. This includes documenting medical and disability case management strategies for claim resolution, based on clinical expertise. Adheres to confidentiality policy. Includes written correspondence as needed to prescribing physician(s) and refers to physician advisor as necessary
Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable
Establishes effective return to work plans with employer, injured employee, provider and other parties as needed. Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment
Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution
Communicates effectively both verbal and written with medical professionals, claims adjuster, client, vendor, supervisor and other parties as needed to negotiate, coordinate appropriate medical care and effective return to work plans utilizing critical thinking skills, clinical expertise and other resources needed to achieve an optimal case outcome
Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives
Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim
Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director)
Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards
May assist in training/orientation of new staff as requested
Other duties may be assigned
Supports the organization's quality program(s)
Qualification
Required
Active unrestricted RN license in a state or territory of the United States required
Minimum Five (5) years of related experience required to include two (2) years of direct clinical care AND three (3) years of combination of either case management/managed care setting/discharge planning/utilization management required
Knowledge of workers' compensation laws and regulations
Knowledge of case management practice
Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
Knowledge of behavioral health
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Leadership/management/motivational skills
Analytic and interpretive skills
Strong organizational skills
Excellent interpersonal and negotiation skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Preferred
Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred
Certification in case management, rehabilitation nursing or a related specialty is highly preferred (CCM, COHN, CRRN, etc)
Preferred for license(s) to be obtained within three - six months of starting the job
Written and verbal fluency in Spanish and English preferred
Preferred previous clinical experience emergency room, critical care, home care or rehab experience
Benefits
Medical & Dental Plans
Life Insurance, including eligible spouses & children
Health Care Flexible Spending
Dependent Care
401k Savings Plans
Paid Time Off
Company
AmTrust Financial Services, Inc.
AmTrust Financial Services, Inc., through its subsidiaries, operates as a multinational property and casualty insurance company.
5001-10000 employees
Funding
Current Stage
Public CompanyTotal Funding
unknown2006-11-13IPO
Leadership Team
D
Daniel Pacicco
Executive Vice President, Chief Financial Officer
Carl Canales
Executive Vice President - North American Field Operations
Recent News
2025-11-07
2025-11-05
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