Field Nurse Consultant Workers' Compensation

Santa Barbara Cottage Hospital; United States; Remote; USD 82,000 - 104,000; Full time

Job summary

A leading healthcare provider is seeking a Remote Case Manager to effectively conduct field case management and disability management for injured workers. The role involves managing claims, communicating with various stakeholders, and ensuring a smooth return to work process. Candidates should possess a nursing degree and relevant experience, with strong communication and negotiation skills being essential. This position offers a competitive salary and comprehensive benefits.

Benefits

Medical, Dental and Vision Insurance

Flexible Spending Accounts

Paid Parental Leave

Life, AD&D and Disability Insurance

401(k), Employee Share Purchase Plan (ESPP)

Education and Training Reimbursement

Paid Leave: 3 weeks/year Vacation

10 paid Company Holidays

Employee Assistance Program (EAP)

Qualifications

• 1 year clinical experience required, minimum 3 years preferred.
• Preference for previous insurance, managed care or utilization experience.

Responsibilities

• Manage an assigned caseload of medical and disability workers' compensation claims.
• Communicate with injured employees and medical professionals to gather necessary information.
• Document interventions and recommendations in the Zenith system.

Skills

Communication

Negotiation

Bilingual in Spanish

Education

Bachelor of Science in Nursing

Registered Nurse (R.N.) License

Tools

Microsoft Outlook

Microsoft Office

Job description

This is a Remote position.

Candidates must reside in the Central Valley, CA area.

This position is eligible for a company car.

Effectively conduct field case management, disability management, and utilization review as indicated for injured workers with the goal of returning the injured person to employability and normal activities or achieving maximum medical improvement (MMI).

The essential functions of this position include, but are not limited to, the following:

• Prioritize and manage an assigned caseload of medical and disability workers' compensation claims according to Zenith guidelines, performing UR and field case management, as indicated.
• 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, 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
• Demonstrate critical thinking and analysis in coordinating and managing medical care for injured workers to promote medical stability and return to work
• 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 as needed and within corporate guidelines.
• Applies principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• 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.

Education, Skills and Experience Requirements

• Degree from an accredited nursing school required, with Bachelor of Science in nursing preferred.
• Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
• Valid Driver’s License in good standing.
• Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers’ compensation and utilization review practices.
• 1 year clinical experience required. Minimum 3 years preferred with practice with experience in orthopedics, neurology, or occupational medicine preferred. Preference for previous insurance, managed care or utilization experience.

• Preference for previous insurance, managed care or utilization experience.

• Secures professional certification such as CCM, CDMS, CRRN or COHN with two years
• 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.
• Bilingual in Spanish a plus.

The expected salary range for this position is $82,592.28 to $103,240.35. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law.

Qualifications may warrant placement in a different job level.

Benefits

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
• Employee Assistance Program (EAP)
• For more information, review details on the Benefits page of our Career Site:https://www.thezenith.com/careers/benefits/

Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant’s criminal history until after a conditional offer of employment has been made.

If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.

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