[Hiring] Field Nurse Consultant Workers' Compensation @Zenith Insurance Company

Role Description

This role involves managing a caseload of medical and disability workers compensation claims according to Zenith guidelines.

• Conduct in-person and telephonic assessments of injured workers to evaluate injury status, treatment progress, functional capacity, and barriers to recovery.
• Attend medical appointments as needed to facilitate communication between providers, injured workers, and claims stakeholders.
• Review medical records, diagnostic studies, and treatment plans to assess appropriateness, progress, and consistency with evidence-based guidelines.
• Identify treatment delays, non-adherence, psychosocial risk factors, and other obstacles impacting recovery.
• This is a remote role with a preferred location around the Fresno, Salinas, Monterey, and Modesto area in California.
• The selected candidate will be provided with a company car for travel.

Responsibilities

• 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 external field case managers, 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.
• 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, within corporate guidelines.
• 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.

Qualifications

• Regular and reliable attendance is required; must be able to work at least 37.5 hours per week, Monday through Friday, and be available for extended hours as situations arise.
• Position may require extensive travel and remote working conditions, or overnight travel.
• Must be available to work catastrophes (CAT) requiring travel to CAT sites with varied claims responsibilities and for extended periods of time beyond the typical work week.

Education

• Must be a Registered Nurse or similar.
• High School Diploma or equivalent combination of education and experience required.
• Bachelor’s Degree or equivalent combination of education and experience preferred.
• Certified Case Manager (CCM) certification is a plus.

Work Experience

• 3+ years of experience maintaining a current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.

Knowledge, Skills, and Abilities

• Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers’ compensation and utilization review practices.
• 3 years recent experience working remotely either in a telephonic or field case management role with a preference in workers’ compensation.
• 3 to 5 years clinical practice with experience in orthopedics, neurology, or occupational medicine preferred.
• Possesses or pursues additional professional certifications; such as CCM, CDMS, CIRS, CRRN or COHN.
• 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 Spanish a plus.
• Valid Driver’s License in good standing.

Pay, Benefits, and Other Information

• The expected salary range for this position is $85,736.31 - $105,000. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law.
• 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).