WORKERS COMPENSATION NURSE CASE MANAGER

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At Riverside, everyday brings new and exciting challenges. You can expect an interesting environment where you’re part of making sure our organization is running optimally and safely, helping keep the community healthy. We provide the kind of paid training and opportunities that long-term careers are built on and we recognize hard workers who strive to make a difference. You will be able to succeed in our close-knit, safety-focused culture working together as a team. The careers we offer are meaningful because the work we do matters. Join us!

FTE: 1.000000

Shift: Days

Location: Atrium

Summary:

The Worker’s Compensation Nurse Case Manager is a Registered Nurse or Licensed Practical Nurse who provides coordination of care, case management, and facilitates timely return to work for occupational health injuries. The Nurse Case Manager serves as a liaison between all affected parties involved in the workers' compensation claim, including doctors, therapists, the injured worker, the employer and the insurance company. The Nurse Case Manager will assure that medical care is progressing effectively and identify any problems related to that care.

Education : Successful completion of a practical nursing program or graduate of school of nursing

Work Experience : 3 or more years of case management for occupational health

Licenses & Certification : Registered Nurse Licensed in the State of Illinois or Licensed Practical Nurse with successful completion and certification. CPR certification. DOT and Drug Screen Certifications.

Responsibilities:

• Obtain all workers’ compensation patient claim information, including the insurance company processing the claim, claims adjustor handling the file, claim number, and claim status.
• Act as a liaison between patients, providers, employer, and all affected parties to ensure prompt and effective injury treatment. Communicate with all affected parties the patient’s ongoing injury treatment status.
• Ensure all services, treatment, referrals, and procedures are authorized by the responsible party, scheduled accordingly and timely.
• “Follow” the patient’s status from initial injury treatment to ultimate deferral and/or discharge from the occupational health provider.
• Maintain ongoing files of the open cases and their status for the provider on a weekly basis. Update documentation in the occ health software daily and ensure it is checked for errors.
• Ensure updated records, progress reports, testing documentation, and lab results are disseminated to all affected parties in a timely manner.
• Assist provider in preparation of appeals for insurance denials for injury treatment/procedures.
• Complete any insurance forms, FMLA forms, disability forms at the request of the patient.
• Coordinate care with respect to provider orders and referrals; initiate email and/or speak to provider daily in order to communicate patient progress.
• Oversee and schedule in-house patient specialist appointments and ensure that recommendations and orders given by the specialists are carried out.
• From time to time in the event of staffing shortage or volume surge, the Nurse Case Manager will be called to the floor in order to assist the Team with patient care. This may include and not limited to rooming patients, perform drug screens, N95 fit tests, and breath alcohol testing or any other service offered in the clinic.
• Administrative tasks as directed.
• Assist with protocol and process implementation.
• Nurse Case Manager will cooperate with managerial decisions pertaining to the parameters of his/her job.
• Obtain authorizations required for testing and treatment ordered by the providers.
• Maintain professionalism when faced with the demands associated with the position.
• Proactively manage all active claims to assess progress, prevent lapses or delays in treatment, obtain regular updates on work status, and facilitate injured worker’s timely return to work.
• Identify client needs with high injury rates and works with those clients to promote safe work practices.
  

• Provide education to injured worker and our clients.
• Maintain knowledge of workers’ compensation laws and regulations.
• Other duties as assigned.
• Knowledge of current literature for worker’s compensation and/or occupational health
• Knowledge and understanding of OSHA guidelines and recommendations
• Excellent verbal, written and communication skills
• Excellent attention to detail and organization skills
• Ability to coordinate care between multiple parties
• Ability to educate staff and patients
• Ability to make knowledgeable clinical assessments
• Ability to work independently, collaboratively and possess initiative
• Ability to work as a team and jump in to help the clinic with patient care
  

Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.

Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.

Other information:

Exposure/Sensory Requirements:

Exposure to:
Chemicals: Refer to MSDS Sheets
Video Display Terminals: Average
Blood and Body Fluids: Obtaining and transporting patients' body fluids.
TB or Airborne Pathogens: Minimal - Exposure potential reduced through the use of universal precautions.

Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Needed for communication with patients, other staff and outside companies
Vision: Needed to read materials such as medical records.
Smell: Needed to detect the odor gas or electrical hazards.
Hearing: Required for patient safety, telephone use, and vital signs.
Touch: Required for pulse taking, supportive/comforting interventions and control.

Activity/Lifting Requirements:

Average Hours per Week:40

Shift: All

Percentage of time during the normal workday the employee is required to:
Sit: 20%
Twist: 5%
Stand: 20%
Crawl: 3%
Walk: 25%
Kneel: 3%
Lift: 5%
Drive: 0%
Squat: 5%
Climb: 5%
Bend: 5%
Reach above shoulders: 5%

The weight required to be lifted each normal workday according to the continuum described below: l
Up to 10 lbs: Frequently
Up to 20 lbs: Occasionally
Up to 35 lbs: Occasionally
Up to 50 lbs:Occasionally
Up to 75 lbs: Occasionally
Up to 100 lbs: Not Required
Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Putting away supplies. Lift above the head occasionally to place boxes on high storage shelves. Carry boxes up and down the stairs - distances up to 100 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 60
Twist: 3
Stand:15
Crawl: 1
Walk: 60
Kneel: 3
Lift: 3
Drive:0
Squat: 3
Climb: 2
Bend: 3
Reach above shoulders: 1

Repetitive use of hands (Frequency indicated):
Simple grasp Normal weight: Frequently
Pushing & pulling Normal weight: Occasionally
Fine Manipulation: Writing, taking vital signs.

Repetitive use of foot or feet in operating machine control:

Environmental Factors & Special Hazards:

Environmental Factors (Time Spent):
Inside hours: 7
Outside hours : 1

Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Dry
Atmosphere:

Special Hazards: Other - potentially aggressive/violent patients.
Protective Clothing Required: Gloves to maintain MHU universal precautions.