Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.
We have big hearts and love big ideas. We celebrate continuous improvement, innovation, compassion, teamwork, integrity and excellence. Speaking of celebrating, we love having fun at work. We host holiday parties, on-site painting classes, and employees love our yoga classes and book club, too.
What you’ll do:
Our Medical Case Managers work with claims personnel and other internal/external stakeholders to assist bringing medical and claims issues to an expedient and cost-effective resolution. Provides Pinnacol and our stakeholders with best in class customer service through medical case management.
What you can expect:
- Contact injured workers on a timely basis to document circumstances of injury, pre-injury condition, comorbid conditions and past medical/surgical history
- Serve as medical resource to injured workers answering questions relating to diagnosis, care plan, and progression of care to reach treatment goals on expedient basis
- Collaborate with claims representatives to evaluate requests for change in provider in compliance with CO Workers’ Compensation rules and procedures
- Review and document provider’s treatment plan to confirm that it is consistent with appropriate protocols including evidence based best practice and CO Workers’ Compensation treatment guidelines
- Determine if treatment plan needs additional review by Company physician adviser to assure adherence to treatment plan
- Refer any deviations in treatment plan by Select Net providers to provider relations department
- Dialogue with claims representatives regarding the injured workers’ progression through and completion of timely and appropriate medical treatment
- Identify opiate and psychotropic drug use to mitigate excessive use and assure cost containment
- Review and discuss requests for high dollar medical equipment with appropriate Company staff to include: prosthetics, home modifications, vehicle purchase, rental, or modification, extended duration of professional home health care services and family members providing home healthcare services
- Submit physician peer review letters for medical benefit denials to requesting parties within predefined time constraints reducing any potential for penalties and reverse denials
- Collaborate with return to work specialist to facilitate return to work on lost time claims
- Refer claims for external case management service per departmental guidelines
- Communicate with customer to actively support new business and business retention
- Work closely with population health management team to identify and manage targeted claims
- Serve on various committees and task forces as required
- Other duties as assigned
What you’ll bring to the table:
CO nursing or Physician Assistant license required; must maintain a current license. Must attain and maintain case manager certification within 3 years of hire. Completion of a degree/certification is encouraged and supported. Five years’ experience in nursing strongly preferred
Regular attendance required. Extensive telephone and computer work in an office environment including extensive field activities: travel via personal automobile within the state is required; must possess valid Colorado driver’s license and proof of automobile insurance.
We can’t do our work without people like you.
Our employees are extraordinary and committed to making a difference. Here’s some of the ways we show our appreciation.
- Our benefits go beyond the basics. You’ll get to choose from diverse benefit offerings for medical, dental and vision.
- We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers.
- Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus eight paid holidays annually.
- Take care of yourself. Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes
- Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
- Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
- Share in our success. You’ll have the opportunity to earn a quarterly incentive, up to 20 percent of your annual base salary, when your team exceeds their goals and objectives.
When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you’d like to be paid, what similar jobs pay in the Denver area and make sure there’s equal pay for equal work among those you’ll be working with.
Want to love your work? Apply today!