Workers Compensation Telephonic Nurse Case Manager

FUNCTION OF THE JOB:

 The Workers Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of optimum medical improvement. The TCM is responsible for disability management, including proactive early return to work coordination. Close collaboration with the claims and medical team to achieve individual case and department goals is a critical component of the position. This is a full-time remote position with preferred location of Eastern Time Zone.  

KNOWLEDGE AND SKILLS:

Excellent verbal and written communication skills. This position will involve continuous personal, telephonic, and written contact. Strong interpersonal and relationship building skills.  Knowledge of traumatic injuries and the resultant disabilities and medical complications.  Knowledge of Worker’s Compensation Acts and working knowledge of the medical providers in the assigned territory.   Knowledge and expertise in use of medical treatment guidelines and disability duration guidelines.  Experience using Microsoft Office products and ability to learn other technology tools.  Strong time management, critical thinking, and organizational skills with the ability to work independently to manage priorities and meet deadlines

 MAJOR DUTIES/RESPONSIBILITIES OF THE JOB:

Complete timely initial assessment report, case management plan, and establish disability duration timeframes.  Throughout the life of an assignment review, analyze and critically assess medical records compared to evidence-based treatment guidelines; communicate findings and recommendations to the adjuster as part of the development of a medical action plan.  Active participation with claims team to review, establish, and execute action plan.  Develop and maintain action plan for early return to work (RTW) based on disability duration guidelines.   Work collaboratively with all stakeholders to effectively manage recovery and return to work process.  Meet productivity requirements.   Effectively manage inventory based on guidelines.   

Qualifications

EDUCATION AND EXPERIENCE:

Registered Nurse (RN) license in good standing required and willingness to obtain additional licenses as needed.   Certified Case Manager (CCM) certification a plus  3-year experience in Workers Compensation Case Management preferred. Bi-lingual in Spanish a plus