WORKERS' COMPENSATION MEDICAL CASE MANAGER

POSITION GOAL

The Workers’ Compensation Nurse Case Manager is responsible for first-line telephonic medical case management related to individual claims.  This position is responsible for determining and executing all medical consumerism activities on individual claims, with the principle goal of assuring accurate issue/problem identification, facilitating appropriate clinical/medical resolution (return to health) and optimal functional restoration, including Stay-at-Work/Return-to-Work (SAW/RTW).

ESSENTIAL PERFORMANCE RESPONSIBILITIES

The Workers’ Compensation Medical Case Manager shall carry out the performance responsibilities listed below:

• Serve as custodian of intellectual integrity of the District’s workers’ compensation program core principles.
• Build a strong partnership with paired adjuster in order to support and integrate the delivery of medical services into the overall claim strategy.
• Develop individual medical action plans in order to bring claims to appropriate closure.
• Identify specific claim issues encountered during daily medical management activities, determine appropriate solutions and reach collaborative resolution of issues.
• Manage assigned inventory of claims to appropriate closure through application of pro-active medical consumerism activities including authorizations, referrals and reimbursement.
• Serve as a conduit of medical information by documenting and communicating relevant medical activity within the claims administration system and among appropriate claim parties.
• Make determinations regarding initial and ongoing investigation of medical causality.
• Assess the health and functional status of employees through collection of medical and disability data.
• Evaluate medical record history in order to provide guidance and advice regarding all aspects of claims decisions, including denial.
• Utilize appropriate claim diary management practices/actions (scheduling of future medical case management activities).
• Identify and escalate claims meeting pre-determined criteria to the medical supervisor.
• Participate in multi-disciplinary team meetings for the purpose of “roundtable” group evaluation, planning and implementation of case strategy.
• Review claim level data and reports to effectively manage day to day medical activities.
• Prepare medical abstract reports for incorporation into “roundtable” reviews, reporting to the District’s excess carrier, defense counsel, and other claim parties/strategic partners as appropriate.
• Serve as patient advocate, orient, principle contact during claim, coordinates & explains medical care concerns, issues and activities, facilities SAW/RTW, etc.
• Utilize merits-based decision-making at all times, based on the integration of the relevant; case-specific case facts, science & evidenced-based medicine, and statutory parameters.
• Serve as principal facilitator of SAW/RTW efforts and coordination.
• Provide objective feedback regarding cooperation, performance and other relevant parameters regarding clinicians, location administrators/representatives, and other system participants to support macro program management activities. 
• Maintain technical competency and currency through continuous and regular review of relevant industry developments, literature, and other technical sources of information, as well as participation in conferences and other continuing education opportunities.
• Perform and promote all activities in compliance with the equal employment and non-discrimination policies of The School Board of Broward County, Florida.
• Participate in training programs offered to enhance the individual skills and proficiency related to job responsibilities.
• Review current developments, literature and technical sources of information related to job responsibilities.
• Ensure adherence to safety rules and procedures.
• Follow federal and state, as well as School Board policies.
• Perform other duties as assigned by the immediate supervisor or designee.

MINIMUM QUALIFICATIONS & EXPERIENCE

• A nursing degree from an accredited institution or nursing certification from an accredited nursing program.
• A minimum of two (2) years of clinical nursing experience and/or one (1) year telephonic handling of all aspects of workers’ compensation medical case management including facilitation and coordination of medical care, medical consumerism, stay at work/return to work coordination, and determination of medical causality.
• An active Florida Registered Nurse license in good standing. 
• Medical case management certification such as Certificate in Certified Case Manager (CCM) or Certification in Critical Care Registered Nurse (CCRN) (if no certification, must agree to obtain within 1 year). 
• Computer skills as required by the position.

PREFERRED QUALIFICATIONS & EXPERIENCE

• Bilingual skills.

SIGNIFICANT CONTACTS-frequency, contact, purpose

May occasionally interact with contracted service providers to ensure the District’s Workers’ Compensation program is consistent with SBBC’s strategic direction, policies and procedures. Will regularly communicate with claim stakeholders including but not limited to injured workers, location administrators, physicians and other clinicians, defense counsel, regulators, and others to discuss individual claims tactical information for the purpose of issue or claim resolution.

PHYSICAL REQUIREMENTS

Light work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently as needed to move objects.

TERMS OF EMPLOYMENT

Salary and benefits shall be paid consistent with the District's approved compensation plan. Length of the work year and hours of employment shall be those established by the School Board.

LINK TO JOB DESCRIPTION

To review the complete job description, access the following website: https://www.browardschools.com/Page/36072 and search by Job Code. The Job Code for this position is:  CC-067

LOCATION PREFERENCES/ADDITIONAL INFOR