Jobs in Occupational Health Nursing

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  1. Job Title
  2. Job Description & Qualifications
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RN Senior Worker's Compensation Case Manager
HealthPartners

We have an exciting full time position for a RN Senior Worker's Compensation Case Manager. The Senior Case Manager provides case management services to employers and employees contracted with the HealthPartners Work Site Health. Case management's goal is to ensure appropriate use of medical resources to facilitate optimal medical care including optimal timing of return to work for employees of companies contracting with HealthPartners Worksite Health.

At HealthPartners, you'll find a culture where we live our values of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health and well-being, create exceptional experiences for those we serve and make care and coverage more affordable.

Accountabilities:
Case Management:

  • Collects and evaluates pertinent medical information in a timely manner, acts on that data to ensure high quality medical care, including the appropriate early return to functional activity of the monitored patient. Develops and implements case management goals and objectives consistent with the treatment and return to work plan.
  • Identifies in a timely manner, tracks and monitors all injured worker cases.
  • Categorizes cases into stratified levels of case management intervention using established criteria.
  • Identifies cases that deviate from standards of care for medical or disability care delivery and intervenes on such cases in a timely manner to bring the care in line with standards of care, or documents medical necessity for the deviation.
  • Maintains good working relationships with other case managers and the Medical Director.

Communication and Education:

  • Provides timely and complete communication to providers, employee/patients, and employers concerning medical decisions, deviations from standard of care, and applicable guidelines, using education as the preferred method of addressing discrepancies by the various customers.
  • Uses established criteria such as ICSI, MN DOLI treatment guidelines, Presley Reed, Milliman and Robertson as teaching tools for the providers as appropriate for individual cases. Educates network providers to pro-actively involve case management services in potentially complicated cases.
  • For Worker's Compensation Managed Care plan (WC MCP), approves and monitors "out of network" provider referrals and medical service delivery of "out of network" providers required WC MCP materials to "out of network" providers.
  • Communicates with key customers (e.g., providers, payers, employees, employers, and QRC (if assigned)) to ensure they understand the rationale behind case management decisions.
  • Ensures timely Return to Work (RTW) form completion and facilitates communication of this and other required medical records to the employer and payer for expediting RTW planning, compensability determination and payment of claims.
  • Involves the medical director in a timely manner on specific cases, based on mutually developed criteria.
  • For WC MCP, assists administrative staff in meeting with designated employer contacts as required to assess occupational health needs and develop customized plans to meet their needs for successful workers' compensation managed care. Includes participating in establishing supervisor training plan and communication procedures, reviewing job descriptions, Return to Work (RTW) plans, and assessing worksite for safety and ergonomic concerns.
  • For WC MCP, assists administrative staff as needed with onsite pre-implementation instruction and training sessions to managers and supervisors. Information covered includes outlining employer responsibilities including employee notification according to the Workers Compensation Managed Care Rules.

Medical Resource Management:

  • Ensures timely, appropriate and efficient use of medical resources, diagnostic testing, subspecialty referral, ergonomic evaluation, second opinion and adversarial examinations while facilitating early return to functional activity of the monitored patient.
  • Facilitates moving the employee through the health care system and achieving timely implementation of treatment plan.
  • Works with providers as an advocate and partner to negotiate treatment plans as needed to obtain "win-win" outcomes.
  • Negotiates with employers and/or direct supervisors to facilitate early RTW.
  • Ensures goal oriented medical treatment plans that reflect subjective, objective and functional outcomes and that are consistent with ICSI, MN. DOLI, HealthPartners guidelines, etc.
  • Intervenes in cases where treatment deviates from standards of care to bring them in line or document medical necessity.

Tracking and Reporting:

  • Provides regular reports including type of disability, length of time off, limited duty time, and dedicate outcome using the patient, provider and employer as appropriate in order to identify trends that can be analyzed for implementing strategies to reduce workplace injuries/illness and associated cost.
  • Provides information in a timely manner as required to employers and/or payer to expedite billing and claims payment, adjudication, utilization review, and for tracking and reporting purposes.
  • Uses computer tracking system, which serves as the medical record and provides data for reporting purposes.
  • Provides regular reports as required to employers and/or payers.

Supervision:

  • Responsible for developing, maintaining and performing quality assurance audits on select cases in order to assure uniformity and consistency in all aspects of medical management.
  • Acts as the medical expert and consultant for the other nurses in the department.

Required Qualifications:

  • Registered Nurse with current Minnesota nursing license.
  • Five years' experience in related nursing field (e.g., occupational health, emergency medicine, etc.) including at least two years' experience in worker's compensation case management.
  • Demonstrated current working knowledge of the Minnesota Workers' Compensation rules and systems including Workers' Compensation Statutes, and Treatment Parameters.
  • Demonstrated current working knowledge of Managed Care Rules as well as OSHA, ADA, FMLA if applicable.
  • Demonstrated knowledge and skill in short-term disability case management
  • Demonstrated expertise in outpatient disability case management.
  • Strong computer skills using Microsoft Word and Excel or similar applications.
  • Excellent oral and written communication skills
  • Strong negotiation skills
  • Strong time management and organizational skills
  • Strong complex problem-solving skills.
  • Knowledgeable and resourceful in developing community resource network.
  • Demonstrated ability to work in collaborative fashion with other case management team members.

Preferred Qualifications:

  • Previous experience as a case manager with a Minnesota Workers' compensation Managed Care Plan.
  • Master's degree in Occupational Health, Public Health, or other related field.
  • Certified Occupational Health Nurse (COHN).
  • Experience with case management software, electronic interfaces such as automated medical record and E-mail.

HealthPartners is recognized nationally for providing outstanding care and experience for patients and members. We offer an excellent salary and benefits package. For more information and to apply go to www.healthpartners.com/careers and search for Job ID #52072. You can email Staci Darling with questions at staci.l.darling@healthpartners.com.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Date to Remove: 2019-06-15


 

Process Followed for MAOHN Job Postings:

  1. Company is to notify via email to: maohn.org their request for a job posting, preferable in .pdf format or appropriate reproducible format for website.
  2. Company is to include an "end date" for posting.
  3. Company is to include their contact information.
  4. Postings must be for an actual job position available, not open resume collection.
  5. Representative from PR committee for MAOHN, reviews the request for authenticity and appropriate venue for posting at maohn.org.
  6. If representative of PR committee of MAOHN approves the request, they are then to forward to our Webmaster, Eric Schmid, indicating he may post this job at our website.
  7. Webmaster will then individually post job for predetermined time.
  8. Company is responsible to notify maohn.org if they want job posting removed prior to deadline or if changes are needed to the posting.
  9. MAOHN is not responsible for the content of job posting accuracy, this is the sole responsibility of the company requesting free job posting.
  10. Job postings at MAOHN are a service to our membership and MAOHN does not earn revenue from job postings.

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