Requisition Number: 6039T02753
Preferred Office: Charlotte, NC. Will consider Austin, TX with strong preference to Charlotte
Effectively conduct telephonic case management, disability management, and utilization review as indicated for injured workers with the goal of returning the injured person to employability and normal activities or achieving maximum medical improvement (MMI).
The essential functions of this position include, but are not limited to, the following:
- 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
- Demonstrate critical thinking and analysis in coordinating and managing medical care for injured workers to promote medical stability and return to work
- 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 as needed and within corporate guidelines.
- Applies principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
- Work productively and harmoniously with others on a consistent basis.
- Respond positively to direction and feedback on performance.
- Consistently maintain professional and appropriate demeanor.
- Perform other duties/projects as assigned.
Education, Skills and Experience Requirements
- Degree from an accredited nursing school required, with Bachelor of Science in nursing preferred.
- Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
- Valid Driver’s License in good standing.
- Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers’ compensation and utilization review practices.
- 1 year clinical experience required. Minimum 3 years preferred with practice with experience in orthopedics, neurology, or occupational medicine preferred. Preference for previous insurance, managed care or utilization experience.
- Secures professional certification such as CCM, CDMS, CRRN or COHN with two years
- 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 in Spanish a plus.
*Qualifications may warrant placement in a different job level*