Senior Manager Workers Compensation / RN

Emory Healthcare•Atlanta, GA

3h•Hybrid

About The Position

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs And more Description Job Summary The Workers Compensation Manager is responsible for the strategic and operational oversight of the Workers' Compensation programs for Emory Healthcare and Emory University. This role provides subject matter expertise in the management of medico-legal claims, regulatory compliance, and case management operations to ensure high-quality, cost-effective outcomes for injured employees. The position partners closely with internal and external stakeholders to promote injury prevention, timely return-to-work, and continuous program improvement while ensuring adherence to State Board of Workers' Compensation and OSHA requirements. Key Duties and Responsibilities Program Leadership & Strategy 1. Lead and manage the Workers' Compensation programs for Emory Healthcare and Emory University, ensuring alignment with organizational objectives and regulatory requirements. 2. Provide subject matter expertise on the strategic management of medico-legal claims and complex case scenarios. 3. Assess, implement, and monitor program options and services to meet employee health needs while promoting quality and cost-effective outcomes. 4. Develop, implement, and evaluate collaborative clinical pathways and case management models to enhance program efficiency and effectiveness. 5. Partner with senior leaders and stakeholders to identify opportunities for continuous improvement and risk mitigation. Claims Management & Return-to-Work 1. Oversee case management for prolonged, complex, or litigated workers' compensation claims to facilitate appropriate care and timely return-to-work. 2. Partner with supervisors and department leaders to identify, implement, and promote return-to-work strategies aligned with State Board of Workers' Compensation and industry best practices. 3. Coordinate care and services with nurse case managers, advanced practice providers, third-party administrators, and external healthcare providers. 4. Monitor claim progression and outcomes to ensure adherence to clinical, legal, and operational standards. 5. Support accident investigations through root cause analysis and implementation of corrective actions to prevent recurrence. Regulatory Compliance & Risk Management 1. Serve as the primary point of contact for State Board of Workers' Compensation communications, including stipulations, notices, and reporting requirements. 2. Collaborate with Environmental Health and Safety (EHSO) and Quality teams on OSHA log reconciliation, posting, and compliance activities. 3. Review and maintain compliance with state and federal workers' compensation laws, OSHA regulations, and internal policies. 4. Conduct annual reviews of the Panel of Providers and make recommendations to ensure regulatory compliance and operational alignment. 5. Facilitate periodic meetings with Panel Providers to ensure adherence to reporting, documentation, and process requirements. Vendor & Financial Oversight 1. Manage third-party vendor relationships, including TPAs, PBMs, legal partners, and field case management services, ensuring service level agreements and performance guarantees are met. 2. Review, interpret, and analyze metrics and reports provided by business partners, including monthly expenditure and utilization reports. 3. Share performance, trend, and budget data with the Director and applicable internal stakeholders to support informed decision-making. 4. Monitor program expenditures to ensure adherence to approved budgets and financial targets. 5. Identify opportunities to improve vendor performance, cost containment, and service quality. People Leadership & Collaboration 1. Supervise, mentor, and develop nurse case managers, workersÂ¿ compensation professionals, and advanced practice providers. 2. Develop, implement, and evaluate staff performance using defined key performance indicators and competency standards. 3. Manage day-to-day staffing operations, including training, hiring, performance evaluations, and quality improvement initiatives. 4. Collaborate with Human Resources, Operations, EHSO, and other partners to design and implement programs supporting injury prevention and employee health. 5. Contribute expertise to the development of controls and surveillance strategies addressing actual and potential workplace hazards. Additional Duties as Assigned

Requirements

Education: Bachelor's degree in nursing from an accredited school of nursing.
License: Active, unincumbered RN license from the State of Georgia or an active and unencumbered RN license that meets eligibility requirements to practice in the State of Georgia.
Experience: Five (5) years of occupational health experience including two (2) years of healthcare leadership experience or ten (10) years of clinical nursing experience.
Certification: Certified Occupational Health Nurse designation (COHN) upon hire or obtain designation within 3 years of hire.
Current knowledge of laws and regulations governing worker and worksite health and safety, including OSHA, workers' compensation, ADA & FMLA.
Proficient knowledge of the regulations set by the Georgia State Board of Workers' Compensation.

Nice To Haves

Education: MSN or MPH degree.
Experience: Medico-Legal Experience related to workers' compensation and claims management.
Occupational Health experience in healthcare setting.

Responsibilities

Lead and manage the Workers' Compensation programs for Emory Healthcare and Emory University, ensuring alignment with organizational objectives and regulatory requirements.
Provide subject matter expertise on the strategic management of medico-legal claims and complex case scenarios.
Assess, implement, and monitor program options and services to meet employee health needs while promoting quality and cost-effective outcomes.
Develop, implement, and evaluate collaborative clinical pathways and case management models to enhance program efficiency and effectiveness.
Partner with senior leaders and stakeholders to identify opportunities for continuous improvement and risk mitigation.
Oversee case management for prolonged, complex, or litigated workers' compensation claims to facilitate appropriate care and timely return-to-work.
Partner with supervisors and department leaders to identify, implement, and promote return-to-work strategies aligned with State Board of Workers' Compensation and industry best practices.
Coordinate care and services with nurse case managers, advanced practice providers, third-party administrators, and external healthcare providers.
Monitor claim progression and outcomes to ensure adherence to clinical, legal, and operational standards.
Support accident investigations through root cause analysis and implementation of corrective actions to prevent recurrence.
Serve as the primary point of contact for State Board of Workers' Compensation communications, including stipulations, notices, and reporting requirements.
Collaborate with Environmental Health and Safety (EHSO) and Quality teams on OSHA log reconciliation, posting, and compliance activities.
Review and maintain compliance with state and federal workers' compensation laws, OSHA regulations, and internal policies.
Conduct annual reviews of the Panel of Providers and make recommendations to ensure regulatory compliance and operational alignment.
Facilitate periodic meetings with Panel Providers to ensure adherence to reporting, documentation, and process requirements.
Manage third-party vendor relationships, including TPAs, PBMs, legal partners, and field case management services, ensuring service level agreements and performance guarantees are met.
Review, interpret, and analyze metrics and reports provided by business partners, including monthly expenditure and utilization reports.
Share performance, trend, and budget data with the Director and applicable internal stakeholders to support informed decision-making.
Monitor program expenditures to ensure adherence to approved budgets and financial targets.
Identify opportunities to improve vendor performance, cost containment, and service quality.
Supervise, mentor, and develop nurse case managers, workersÂ¿ compensation professionals, and advanced practice providers.
Develop, implement, and evaluate staff performance using defined key performance indicators and competency standards.
Manage day-to-day staffing operations, including training, hiring, performance evaluations, and quality improvement initiatives.
Collaborate with Human Resources, Operations, EHSO, and other partners to design and implement programs supporting injury prevention and employee health.
Contribute expertise to the development of controls and surveillance strategies addressing actual and potential workplace hazards.
Additional Duties as Assigned