Workers' Compensation Certified Nurse Case Manager

Consolidated Nuclear Security•Oak Ridge, TN

8d•Onsite

About The Position

This role is responsible for providing comprehensive medical case management oversight of workers’ compensation claims. The goal is to advocate for appropriate services and treatment to attain best practices standards, maximum medical improvement, and successful return-to-work. This involves gathering information, attending medical appointments, communicating with various stakeholders, and collaborating with claim handlers to ensure appropriate treatment plans. The position also requires maintaining high standards of file documentation and providing timely reports and updates.

Requirements

Bachelor’s degree
Minimum 7 years of relevant experience as a workers’ compensation nurse case manager.
RN with current state license required
CCM certification required
Requires a Q clearance; however all qualified candidates will be considered regardless of their current clearance status.
The ability to obtain and maintain a Department of Energy Q clearance is required.
U.S. citizenship is a requirement for security clearance applicants.

Nice To Haves

Knowledge of and working familiarity with the Official Disability Guidelines (ODG)
Knowledge of and working familiarity with the MD Guidelines
Documentation and calculation of cost savings per case
Strong problem solving and analytical skills
Excellent interpersonal, oral, and written communication skills
Good computer skills including use of Word and Excel
Ability to interface with treating physicians, division managers, OHS staff, and employees
Excellent organization skills

Responsibilities

Gather relevant information to assist in the investigation and evaluation of workers’ compensation claims through interviews, verbal or written communications, and medical records.
Help ensure injured parties receive appropriate treatment directly related to their compensable injury.
Attend medical appointments with injured employees.
Communicate in person and by telephone with patients, medical providers, attorneys, and insurance carriers to provide ongoing case management.
Work collaboratively with claim handlers/adjusters to ensure that all injured parties are on an appropriate treatment plan and to manage medical treatment to resolution.
Participate in periodic claim reviews.
Work with others in a tactful, congenial, and professional manner so as to gain their trust and cooperation and accomplish assigned tasks.
Exchange ideas, information, and opinions with others to jointly arrive at decisions, conclusions, solutions, or otherwise solve disputes.
Provide ongoing evaluation of treatment or return to work plan within established protocols.
Interact with Occupational Health Services (OHS) and Environmental Safety & Health (ES&H) to obtain or clarify clinical information and participate in in-house case reviews.
Maintain high standard of file documentation to ensure attention to detail and file accuracy, and provide timely reports, responses, and case updates.
Provide comprehensive medical case management oversight of workers’ compensation claims.
Advocate for appropriate services and treatment to attain best practices standards, maximum medical improvement and successful return-to-work.
Communicate with employees, line management, Occupational Health Services (OHS), occupational safety and health administration (OSHA) recordkeeping, benefits, internal and external counsel, external providers, and others to ensure understanding of, and cooperation with, the recommended treatment plans and the goal of returning employees to meaningful work.
Maintain required continuing education as outlined by CCM, TN Bureau of Workers’ Compensation, and CNS.