BASIC 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 position is located in our Los Angeles, CA claim office.
KNOWLEDGE AND SKILLS:
- Excellent verbal and written communication skills. This position will involve continuous personal, telephone and written contact.
- Strong interpersonal and relationship building skills.
- Ability to work independently and meet deadlines.
- Demonstrate strong skills in time management, organization and critical thinking.
- Knowledge of traumatic injuries and the resultant disabilities and medical complications.
- Knowledge of the local 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 and organizational skills with the ability to work independently to manage priorities and meet deadlines
MAJOR DUTIES/RESPONSIBILITIES OF THE JOB:
- Timely acknowledgment and review of new assignments.
- Timely completion of three point contacts within TCM guidelines.
- Complete initial assessment report and case management plan. Identify appropriate disability duration timeframes. Make recommendations as to further activities and need for continued case management.
- 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 in claim round tables and committee meetings to discuss medical and disability direction and assist claims staff with recommendations for resolving the claim.
- Develop action plan for early return to work (RTW) based on disability duration guidelines.
- Update the employer on work status of employee and verify status of RTW possibilities.
- Meet productivity requirements
- Effectively manage inventory based on guidelines.
EDUCATION AND EXPERIENCE: