Nurse Medical Case Manager - Workers' Compensation

Nurse Medical Case Manager - Workers' Compensation

Prioritize and manage an assigned caseload of medical and disability workers compensation claims according to Zenith guidelines, performing UR and telephonic case management, as indicated.

Communicate with injured employees, medical professionals, claims staff and employers timely and regularly to obtain information necessary to make sound medical assessments regarding diagnosis and prognosis.

Assess injury severity, extent of disability, treatment plans, functional abilities and physical job requirements to establish target return to work plans and / or strategy to manage future medical exposure.

Direct treatment to appropriate panel and network providers, effectively negotiating treatment plans in compliance with Labor Code statutes and company standards.

Utilize and manage resources appropriately, including external field case managers, vendors, UR / peer review, and medical director.

Respond to various written and telephone inquiries timely regarding status of case.

Consistently and accurately document interventions, rationale and recommendations in the Zenith system, utilizing the appropriate templates, and following Zenith guidelines, as indicated.

Facilitate earliest appropriate return to work release and coordinate return to work efforts with all parties, as appropriate.

Facilitate Maximum Medical Improvement and discharge from care.

Educate claims staff, employers and other Zenith staff on medical issues / guidelines, within corporate guidelines.

High School Diploma or equivalent combination of education and experience required. Bachelor's Degree or equivalent combination of education and experience preferred.

3+ Years Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law. required.

Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers' compensation and utilization review practices required. Compact license strongly preferred. 3 years recent experience working in a telephonic or case management role with a preference in workers' compensation. 3 to 5 years clinical practice with experience in orthopedics, neurology, or occupational medicine preferred. Possesses or pursues additional professional certifications; such as CCM, CDMS, CIRS, CRRN or COHN. Strong written and verbal communication skills in order to effectively communicate with injured employees, medical professionals, employers, claims staff and others. Good negotiation skills to successfully establish target return to work dates and manage medical and disability treatment plans. Proficient in basic computer skills, especially Microsoft Outlook and Office. Comfortable in a professional business environment. Bilingual Spanish a plus. Valid Driver's License in good standing.

The expected salary range for this position in East Norriton, PA is $84,177.47 to $105,221.84. The expected salary range for this position in Charlotte, NC is $80,280.37 to $100,350.46. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.

Benefits include Medical, Dental and Vision Insurance, Flexible Spending Accounts, Paid Parental Leave, Life, AD&D and Disability Insurance, 401(k), Employee Share Purchase Plan (ESPP), Education and Training Reimbursement, Paid Leave : 3 weeks / year Vacation, 2 weeks / year Sick Leave, 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays, and Employee Assistance Program (EAP).