POSITION SUMMARY:

Responsible for ensuring the injured associates receive appropriate treatment as ordered by the authorized medical provider directly related to the compensable injury within the parameters of Workers’ Compensation Law. Assists the TPA in managing medical treatment to an appropriate resolution. The Workers’ Compensation Nurse Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured associates. On a case-by-case basis facilitates quality treatment goals, including timely return to work if appropriate.

PRIMARYACCOUNTABILITIES

**

1.Coordinates the injured worker’s medical and physical conditions with the treating physicians, along with discussing/recommending alternate treatment plans for the patient and cost-effective treatment alternatives as appropriate. Manages to conclusion all medical only and lost time claims with a keen emphasis on returning injured associates back to work as soon as possible.

Provides assessment, planning, implementation, and evaluation of patient’s progress and ensures injured worker is on a pro-active, appropriate, cost-effective treatment plan.

Responsible for ongoing evaluation of treatment and return to work plan, within established protocols, assigning field nurses to attend doctors, other providers, and attorney’s visits.

Maintains file quality using timely contact and excellent documentation, maximizing internal resources

60%

2. Monitor effectiveness of services through weekly case reviews with the W/C Team, monthly with TPA, and quarterly with Medical Director; compiling injury type reports and monitoring medical care costs.

15%

3.Gathers relevant information to assist in the investigation and evaluation of the claim, while aggressively pursuing claim resolution opportunities.

5%

4.Utilizes the Occupational Disability Guidelines as a basis to determine appropriateness of medical treatment, upholding applicable state and federal workers’ compensation disability regulatory requirements.

5%

5.With the TPA, coordinates hospital discharge planning conferences for the purpose of determining appropriateness of care and developing an effective long-term care strategy while also coordinating medical treatment and associated diagnostic testing.

5%

6.Obtain job description and discuss job modifications required to ensure a prompt return to work. Identify cases requiring task assignments to field case managers, coordinate with TPA and supervisor.

5%

7.Implements care such as facilitating the delivery of durable medical equipment and nursing services. Devises cost-effective strategies for medical care.

5%

100%

*MINIMUM QUALIFICATIONS *

Education: Associate Degree in Nursing. Work Experience:* Minimum 3 years professional clinical RN experience. *Licensure: *Current Registered Nurse license in Florida. *Certification:None Knowledge/Skills/Abilities:

• Ability to explain medical conditions and treatment plans to the patient, family members, along with the TPA, with professionalism and accurate oral and written communication.
• Strong clinical background with knowledge of medical causation and relatedness as well as use of medical treatment protocols.
• Self-motivated with the ability to perform case management duties independently.
• Build and establish constructive, open and cooperative working relationships with internal and external business partners while also maintaining calm and focus in pressure situations.
• Excellent interpersonal skills, phone etiquette, and organizational skills, delivering outstanding customer service utilizing compassionate care to our customers.
• Proficient in Microsoft Office suite, internet searches and comfort with other software programs.
• Ability to independently prioritize, meet short deadlines, and muti-task with minimal supervision.

PREFERRED QUALIFICATIONS

Work Experience:Minimum 3-5 years’ experience in Case Management or Workers’ Compensation. Certification:* *Certification in Occupational Health Nursing or Certification in Case Management.

• PHYSICAL REQUIREMENTS*

  • Majority of time involves sitting or standing; occasional walking, bending, stooping.
  • Long periods of computer time or at workstation.
  • Light work that may include lifting or moving objects up to 20 pounds with or without assistance. **
  • May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
  • Communicating with others to exchange information.
  • Visual acuity and hand-eye coordination to perform tasks.
  • Workspace may vary from open to confined; on site or remote.
  • May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

Job: *Human Resources

Organization: *Health First Shared Svcs Inc

Title: RN Workers’ Compensation Case Manager - Associate Wellness

Location: Florida - Brevard County-Melbourne

Requisition ID: 075674