Workers’ Compensation Nurse Case Manager

Role Overview

• Assess and analyze injured workers’ medical reports — comparing to evidence-based treatment guidelines, ensuring disability status is supported by diagnosis, work status/restrictions/treatment plan are appropriate, and documentation is correct/complete.
• Access database to reference employer accounts’ modified duty policies and ensure medical reports are communicated and meet client specifications.
• Transmit employee post injury report information to employers via email.
• Communicate with patients in a professional and courteous fashion when needed to discuss changes in work status, restrictions, and treatment plans.
• Maintain productivity on assigned caseloads, which may vary in numbers and/or by state jurisdiction.
• Work with treating physician regarding cases that may need attention or require amendment to ensure appropriate handling and consideration of modified duty is applied to facilitate return-to-work.
• Manage communication (calls, emails) to patients, employers, adjusters and/or nurse case managers regarding any amendments made to case diagnosis, treatment and/or lost time from work.
• Respond to inquiries from employers, adjusters/nurse case managers and patients for documentation or information on Workers’ Compensation cases.
• Learn and be proficient in rules that govern HIPAA and release of medical records to patients, employers, payers, and providers.
• Collaborate with centralized Workers’ Compensation Teams, Occupational Health Support Teams, Sales Team, Clinical Operations Teams, Revenue Cycle Teams and Medical Records Teams to resolve issues and ensure the highest level of customer satisfaction.

Requirements

• Graduate of an accredited school of nursing and possess a current RN license
• Bachelors of Nursing preferred
• Workers’ Compensation case management experience preferred
• Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines
• Must understand Multispecialty terminology and recognize orthopedic diagnoses and diagnostic testing terminology
• Excellent verbal and written communication skills
• Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines
• Experience in the following systems preferred: athenaNet (EMR), Salesforce (CRM)
• Experience working in Microsoft Excel
• High attention to detail
• Customer orientation and ability to adapt/respond to different types of characters
• Ability to remain professional and courteous with customers at all times
• Works well independently and in a team environment
• Certified Case Manager (CCM) certification a plus
• Bilingual in Spanish a plus

Benefits

• health insurance
• dental insurance
• life insurance
• access to a 401k plan