Workers Comp Case Manager

City of Winston-Salem; Winston-Salem (NC); On-site; USD 70,000 - 95,000; Full time

Job summary

The City of Winston-Salem is seeking an experienced Registered Nurse Case Manager to assess work-related injuries and coordinate care for employees. This intermediate professional role requires on-site judgment under supervision and a strong background in occupational health and workers’ compensation processes.

Responsibilities include maintaining medical records under HIPAA, communicating with employees, attorneys, and risk management staff, and ensuring timely treatment decisions.

Qualifications

• Associates/Technical degree with coursework in nursing
• 5 years’ experience in acute care nursing setting
• Familiarity with electronic medical records (EMR)

Responsibilities

• Assess work-related injuries and determine on-site treatment vs. medical facility.
• Maintain Workers’ Compensation records and medical charts.
• Coordinate care with physicians, HR, and Risk Management personnel.
• Attend hearings and maintain case management licensure per NC guidelines.
• Provide health counseling and assist with light-duty planning and documentation.

Skills

First aid & triage

Customer service

Medical records management

Microsoft Office

HIPAA compliance

Education

Associates/Technical nursing degree

Tools

EMR systems

Medical charts management

Job description

General Definition of Work

Performs intermediate professional work assessing work-related and non-worker injuries or health issues, determining whether employee can be treated on site or needs to go to a medical facility, maintaining medical records, and related work as apparent or assigned. Work is performed under the limited supervision of the Assistant Risk Manager.

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Functions

• Workers’ Compensation claim case management for City of Winston-Salem employees.
• Maintain Workers’ Compensation records
• Spot check physical therapy appointments and attend physician appointments
• Maintain weekly contact with employees out of work
• Assist Human Resources staff in providing restricted “Light Duty” work.
• Communicate both in person and by phone with employees, attorneys, and Risk Management personnel
• Evaluate plan of care effectiveness in efforts to reach desirable outcomes
• Prepare weekly reports of case activities
• Attend hearings if requested and maintain case manager licensure, per North Carolina Industrial Commission guidelines
• Other duties as apparent or assigned.
• Note: If currently certified as a registered nurse the following functions may be assigned as time permits: Evaluate and treat employees in a walk-in clinic setting for work related and non-work related illnesses and/or injury, performing first aid and triage for injured workers, administering of OTC medications of daily logs or medical records according to HIPPA guidelines.

Knowledge, Skills and Abilities

Ability to evaluate employees in a walk-in clinic setting for work related illnesses and injuries; comprehensive knowledge of first aid and triage for injured workers; ability to perform monthly inventory and ordering medical supplies/medications/equipment, providing individual health counseling; knowledge of EAP referrals; thorough knowledge of medical charts/OSHA files/FMLA medical forms perpetually; ability to maintain daily log, medical records information according to HIPPA guidelines and other duties as assigned; knowledge of Holistic Wellness programming, teaching health & wellness classes; knowledge of Microsoft Office Suite and position specific software; ability to establish and main maintain effective working relationships with supervisors, co-workers and clients.

Education and Experience

Associates/Technical degree with coursework in nursing, or related field and moderate experience working in nursing or occupational health, 5 years’ experience in acute care nursing setting, and familiarity with electronic medical records.

Physical Requirements

This work requires the frequent exertion of up to 10 pounds of force; work regularly requires speaking or hearing and using hands to finger, handle or feel and occasionally requires standing, walking, sitting, reaching with hands and arms and repetitive motions; work has standard vision requirements; vocal communication is required for expressing or exchanging ideas by means of the spoken word; hearing is required to perceive information at normal spoken word levels and to receive detailed information through oral communications and/or to make fine distinctions in sound; work requires preparing and analyzing written or computer data, visual inspection involving small defects and/or small parts, using of measuring devices, operating machines and observing general surroundings and activities; work is generally in a moderately noisy location (e.g. business office, light traffic).

Special Requirements

• Certified Case Manager through Commission for Case Management or Occupational Health Nurse through American Board of Occupational Health Nurses
• Valid driver’ license
• Registered Nurse - NC State Board of Nursing (preferred)