Field Nurse Consultant Workers' Compensation

Zenith Insurance Company•Fresno, CA

21d•Remote

About The Position

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional. Overview 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. Conduct in-person and telephonic assessments of injured workers to evaluate injury status, treatment progress, functional capacity, and barriers to recovery Attend medical appointments as needed to facilitate communication between providers, injured workers, and claims stakeholders Review medical records, diagnostic studies, and treatment plans to assess appropriateness, progress, and consistency with evidence-based guidelines Identify treatment delays, non-adherence, psychosocial risk factors, and other obstacles impacting recovery This is a remote role with a preferred location around the Fresno, Salinas, Monterey and Modesto area in California. The selected candidate will be provided with a company car for travel

Requirements

Due to the nature of the needs in the position, regular and reliable attendance is required. Must be able to work at least 37.5 hours per week, Monday through Friday, and be available as situations arise requiring extended hours. Position may require extensive travel and remote working conditions, or overnight travel. Must be available to work catastrophes (CAT) requiring travel to CAT sites with varied claims responsibilities and for extended periods of time beyond the typical work week..
Must be a Register Nurse or similar.
High School Diploma or equivalent combination of education and experience required.
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
3 years recent experience working remotely either in a telephonic or field case management role with a preference in workers’ compensation.
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.
Valid Driver’s License in good standing.

Nice To Haves

Bachelor’s Degree or equivalent combination of education and experience preferred.
Certified Case Manager (CCM) certification is a plus.
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.
Bilingual Spanish a plus.

Responsibilities

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.
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.