Position Summary:

This position is responsible for supporting the Corporate Nurse Case Manager with Reyes’ workers’ compensation program and non-occupational disability program.  The Nurse Case Manager will work with the Integrated Disability management (“IDM”) team and all other partners internal and external, to help ensure appropriate, timely, and cost-effective delivery of health care to employees who are injured on the job or away from the job.  The nurse case manager will also assist in our transitional RTW when appropriate to all our employees.

The nurse case manager will report to the Corporate Nurse Case Manager.

Position Responsibilities may include, but not limited to:

Reyes Workers’ Compensation Program

Support Corporate Nurse Case Manager with Reyes’ workers’ compensation managed care programs, including but not limited to triage, injury treatment/management, bill review, WC pharmacy program, and oversee telephonic and field case management.

Support Corporate Nurse Case Manager in the education of field teams to ensure that all injury management programs are utilized.

Support Corporate Nurse Case Manager in the ongoing evaluation and management of managed care vendor partners.

Makes appropriate referrals to internal and external clinical resources (i.e. IME, FCE, Peer Reviews).

Support Reyes’ workers’ compensation claim managers throughout claim to ensure that employees are receiving the best quality care at the right time.

Be a liaison between injured employee, local field team (e.g., HR, general manager), Reyes claim manager, WC third party administrator, and applicable managed care vendor partners to strive for best claim outcomes.

Reyes Disability Program

Support Corporate Nurse Case Manager with Reyes’ non-occupational disability (i.e., Short Term Disability) program.

Support Disability team with clarification and interpretation of medical information received to assess appropriateness of current and ongoing restrictions/limitations and level of impairment.

Identifies pertinent clinical facts and answers questions in collaboration with Disability team and physician consultants.

Support Disability team with recommendations of specific medical information needed to evaluate ongoing level of impairment and to facilitate optimal claim management.

Makes appropriate referrals to internal and external clinical resources (i.e. FCE, Peer Reviews).

Discusses complex medical issues with health care providers as needed and documents outcomes of discussion.

Coordinates and partners with local field teams to support return to work.

Effectively manages assigned caseload.

Communication

Demonstrates clear and concise verbal and written communication skills when interpreting medical information, documenting rationales for clinical opinions, clarifying restrictions and limitations, assisting with return to work and communicating with staff, management and other business stakeholders.

Contacts claimants, internal employer contacts, and health care providers, as indicated.

Must possess initiative and ability to work independently

Training

Educates attending health care providers regarding the need for medical information to support restrictions and limitations.

Achieves and maintains professional credentialing with continuing education units (CEUs) by attending educational seminars and other required educational activities (i.e. ethics, confidentiality)

Supports Corporate Nurse Case Manager in providing training and mentoring to new Disability team members, peers and/or other claim professionals.

Acts as a role model and coach through early assessment of medical issues, work capacity, and RTW opportunities

Other

Other projects or duties as assigned.