Nurse Case Manager

SUMMARY

The Nurse Case Manager (NCM) is responsible for applying medical knowledge in
reviewing workers’ compensation claims to assess, evaluate, plan, implement and
oversee the treatment appropriateness for occupational injuries based upon
evidence based guidelines.  The NCM utilizes clinical knowledge to evaluate the
medical and disability needs of an injured worker against relevant policies,
facilitate coordination of the patient’s medical treatment and timely return to
work. The NCM engages the claimant and physician(s) in providing proactive
medical and disability management, working collaboratively with claim handlers
in providing focused claim resolution and return to work driven outcomes.  The
case management process requires a focus on customer service, skills, knowledge
of setting appropriate goals and measuring outcomes to effectively ensure
optimal outcomes. 

RESPONSIBILITIES/TASKS

The nurse case manager must be able to demonstrate and be accountable for the
standards of practice policies and procedures, quality assurance and the goals
of the organization.  Also, manage treatment of claimants through the workers’
compensation system based on the individual’s diagnosis and state workers’
compensation regulations.

* Obtains and reviews patient clinical status and history to determine casual
nature of patient’s symptoms as related to reported work injuries. 
* Applies knowledge of age-specific, cultural diversity, psycho/social and
developmental issues during the interview process, documentation and
intervention with the claimant, their family or significant other. 
* Determines the medical necessity/reasonableness of proposed and ongoing
treatment as well as inpatient or outpatient hospitalization for each
lost-time case. 
* Formulates all internal and external correspondence necessary to research and
resolve case disputes and case inquiries, contacting providers and involving
claims handlers as required.  Communicates final decision and subsequent
ramifications to claim handlers. 
* Presents, discusses and finalizes alternative care and return to work
programs with permanency ratings assigned to lost-time cases by medical
providers, reinsuring the level of injury and ratings assigned are accurate
and consistent with workers’ compensation, state, industry and division
rating standards and policies, in conjunction with the claim  handler.
* As it relates to California: Adhere to California Nurse Practice Act, Case
Management Code of Professional Conduct and Employee Code of Ethical Conduct

This position description identifies the responsibilities and tasks typically
associated with the performance of the position.  Other relevant essential
functions may be required.

EMPLOYMENT QUALIFICATIONS

Registered Nurse license active and unrestricted required.  Bachelor’s degree in
Nursing (BSN) preferred. Continuous learning required, as defined by the
Company’s learning philosophy. Certification or progress toward certification is
highly preferred and encouraged.

EXPERIENCE

Three years active patient or clinical care experience as a Registered Nurse
required. Three years workers’ compensation case management, occupational
health, rehabilitation or insurance experience preferred. 

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED

* Knowledge of clinical care and jurisdictional requirements.
* Demonstrates the ability to be organized and efficient in prioritizing and
managing assignments with minimal oversight and direction.
* Strong time management skills.
* Excellent oral and written communication, customer service, written report
preparation, human relations and decision making skills are required. 
* Demonstrates use of critical thinking, attention to detail, sound clinical
judgment and assessment skills for decision making. 
* Proficient with computer and Microsoft Windows Suite.
* Demonstrates courteous, professional demeanor and team spirit and the ability
to work in a collaborative, effective manner.

WORKING CONDITIONS

Work is performed in an office setting with no unusual hazards. Minimal travel.

The qualifications listed above are intended to represent the minimum education,
experience, skills, knowledge and ability levels associated with performing the
duties and responsibilities contained in this job description. 

We are an Equal Opportunity Employer. Diversity is valued and we will not
tolerate discrimination or harassment in any form. Candidates for the position
stated above are hired on an "at will" basis.  Nothing herein is intended to
create a contract.

PAY RANGE

Actual compensation decision relies on the consideration of internal equity,
candidate’s skills and professional experience, geographic location, market and
other potential factors. It is not standard practice for an offer to be at or
near the top of the range, and therefore a reasonable estimate for this role is
between $63,000 and $90,400.