Job Description

Job Description

Job Description

ABOUT US:

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY:

Our dynamic Ethos Risk Services is seeking a full-time Telephonic Case Management Nurse (TCM Nurse) to join our Medical Management division to provide professional case management for workers' compensation claims. This role requires critical thinking, problem-solving, and strong communication skills to ensure compliance with state regulations and high-quality medical management.

KEY RESPONSIBILITIES:

• Provide telephonic case management, including assessing claims and communicating with injured workers and healthcare providers.
• Communicates timely with client, both verbally and written, according to Ethos policies and procedures
• Adhere to all deadlines and state statutes.
• Collaborate with clients and document case details per URAC standards and company policies.
• Analyze medical records and clinical criteria to determine appropriate treatment and case direction.
• Ensure compliance with state statutes and deadlines.
• Maintain confidentiality and security standards in a fast-paced environment.
• Assists in promoting and furthering the objectives of the Medical Management Division.

QUALIFICATIONS

Certifications:

• Valid RN License (required)
• Certified Case Manager (CCM) certification (plus)

Experience/Skills:

• Experience in reviewing medical records and identify critical details impacting medical treatments and medical necessity determinations (required)
• Strong knowledge of Microsoft Office and electronic case documentation (required)
• Must be initiative-taking, independent, and accountable. Strength in multi-tasking and clinical prioritization (required)
• Bilingual - English/Spanish (preferred)

WORKING CONDITIONS

• This role is hybrid - 100% on-site in our Houston, TX office with the ability to WFH twice a week after successfully completing training.
• Constant communication via telephone and virtual platforms with clients, customers, and co-workers.
• Office environment or home office with constant temperatures. Prolonged periods of stationary positioning.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.

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