Description
Responsibilities:
The essential functions of this position include, but are not limited to, the following:
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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.
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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.
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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.
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Direct treatment to appropriate panel and network providers, effectively negotiating treatment plans in compliance with Labor Code statutes and company standards.
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Utilize and manage resources appropriately, including external field case managers, vendors, UR/peer review, and medical director.
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Respond to various written and telephone inquiries timely regarding status of case.
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Consistently and accurately document interventions, rationale and recommendations in the Zenith system, utilizing the appropriate templates, and following Zenith guidelines, as indicated.
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Facilitate earliest appropriate return to work release and coordinate return to work efforts with all parties, as appropriate.
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Facilitate Maximum Medical Improvement and discharge from care.
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Educate claims staff, employers and other Zenith staff on medical issues/guidelines, within corporate guidelines.
Qualifications:
Education, Skills and Experience Requirements
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Degree from an accredited nursing school required, with Bachelor of Science in nursing preferred.
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Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
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Valid Drivers License in good standing.
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Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers compensation and utilization review practices.
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3 years experience with a preference for previous insurance nurse case management/utilization review (or equivalent prior experience), preferably in workers compensation.
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3 to 5 years clinical practice with experience in orthopedics, neurology, or occupational medicine preferred.
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Possesses or pursues additional professional certifications; such as CCM, CDMS, CIRS, CRRN or COHN.
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Strong written and verbal communication skills in order to effectively communicate with injured employees, medical professionals, employers, claims staff and others.
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Good negotiation skills to successfully establish target return to work dates and manage medical and disability treatment plans.
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Proficient in basic computer skills, especially Microsoft Outlook and Office.
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Comfortable in a professional business environment.
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Bilingual Spanish a plus.
Attendance Requirements
Due to the nature of the needs in the office, must be able to work at least 37.5 hours per week, Monday through Friday, and be available should a situation arise requiring extended hours.
Physical, Mental & Sensory Requirements
Designated Special Designated
Function % Requirements Yes/No Function Degree
Sitting 70% Hand Manipulation Yes Mathematics Medium
Walking 10% Reaching Yes Reading High
Standing 15% Grasping Yes Verbal High
Bending 3% Visual Yes Written High
Kneeling 0% Auditory Yes Reasoning High
Lifting 2% Driving Yes
Details:
Job Id:
32581613
Posted / Updated:
5/22/2012 5:25:01 AM
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