Registered Nurse Case Manager

Overview

WORKERS' COMPENSATION TRUST

The NHADA Workers Compensation Trust is a self-insured self-administered workers' compensation pool made up of 300 members associated with the automotive industry in New Hampshire. The Nurse Case Manager is one member of a five-member team made up of an underwriter, a workers compensation director, a claims supervisor, and a road claims adjuster. Our members are strongly encouraged to call Nurse case manager immediately following a workplace injury; we have approximately 75% compliance with this request. Nurse case manager takes these calls from either the employer or the injured employee and triages the case immediately. She assesses the injured employees' medical condition, takes a detailed history of the injury, and makes recommendations for treatment within the network of physicians available within our managed care network. Immediately after the initial medical appointment Nurse case manager obtains the medical records and formulates a plan of treatment, physical therapy is pre-approved as needed, and a timeline for referrals to specialty care is developed. The claim is kept on a diary depending upon the original plan to ensure that the employee and care provider are taking the appropriate steps to bring the injured employee to maximum medical improvement. The NHADA Workers Compensation Trust team meets weekly and Nurse case manager's role is imperative to the management of the claim. They contact all out of work employees to assess their compliance and success with the treatment plan and bring the results of those conversations and updated medical information to the meeting. She assists in strategizing a return-to-work plan, while ensuring that the employees' return is within the specific restrictions recommended by the physician. Throughout the process, the employee's privacy and dignity are paramount to the process. At the same time if there is a change in the medical management of the case, Nurse Case Manager makes recommendations, which can be implemented following the meeting. After the employee has returned to work the Nurse Case Manager monitors the care to ensure that the employee continues to receive the support they need to attain maximum medical improvement. The claims manager relies on Nurse Case Manager's feedback to evaluate the efficacy of the program. She makes recommendations for meetings with providers and members who need additional training to ensure that injured employees are receiving appropriate, prompt, and excellent treatment. In addition to the triage of the injured worker, and the medical management of the case, Nurse Case Manager's reviews all medical bills received in our office for accuracy, repricing and to ensure the treatment is reasonable, necessary, and related.

NEW HAMPSHIRE WORKERS COMPENSATION TRUST POSITION TITLE

Registered Nurse Case Manager I. Key Duties and Responsibilities Duty/Responsibility I) Provide intake coverage (phone/email) for injured workers and/or their employers: provide triage services, assist with referrals, document medical information (past & current injury) in claim file. 2) Maintain and monitor medical aspects of all claims: Review all medical bills and records to ensure applicability to case and treatment standards; approve/authorize treatments and medications as appropriate Follow treatment and patient progress; discuss with providers and patients, recommend alternative treatments/schedules as appropriate. Review, maintain, and interpret medical records; document content, advise claims staff regarding applicability to claim. Advise, manage, and support the injured workers on a regular basis through extensive phone contact. Communicate with providers, employers, employees, families, etc. regarding claim status, medical questions, treatment authorization, claim and billing information Complete and deliver all necessary forms and authorizations. Negotiate treatments/schedules/cost of DME and non-network provider services. Prepare and file reports and written communications Participate in case management discussions with other team members 3) Visit medical providers and tour offices to maintain relationships and to ensu.re quality of facility and care injured worker will receive. 4) Provide case analyses/synopses to claims staff as necessary or as requested. 5) Provide input to the budgeting process; perform duties in a fiscally responsible manner. 6) Provide consultation to NHADA employees on general health questions, blood pressure monitoring, and drug information. 7) Plan, research, and write articles for Drive NH. 8) Prepare all documentation according to practices and procedures and in a manner that facilitates understanding of objectives and recommendations. 9) Support team efforts of the organization and the department; offer assistance when needed; share knowledge and resources; respond promptly to inquiries 10) Ensure compliance with all NHADA policies and procedures, and with any applicable statutory or regulatory requirements. 11) Perform additional responsibilities as required. II. Knowledge and Experience This position requires: RN License from the State of New Hampshire Certified Case Manager preferred NH DOL certified injury management facilitator preferred Knowledge of occupational health Case management skills Relationship management skills Organizational and planning skills Persuasive and negotiating skills Computer literacy in Microsoft Office applications Adapt to new computer applications III Typical Recruiting Specifications RN license from the State of New Hampshire and 5 - 7 years experience which includes occupational health and case management in a self-insured or managed care environment. IV. Environment Work is performed in a normal office environment and in the offices of providers. Ability to travel, a car, and a driver's license are required.

Benefits:

• Competitive benefits package include:
• 401(k) with employer match
• Health, Dental and Vision insurance
• Short Term/Long Term Disability
• Paid time off (PTO)
• Employee appreciation events held multiple times per year through an active

Spirit Committee Pay:

$75,000.00 - $85,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Employee assistance program Flexible spending account Health insurance License reimbursement Life insurance Paid sick time Paid time off Tuition reimbursement Vision insurance

Experience:

Case management: 7 years (Preferred) Ability to

Commute:

Bow, NH 03304 (Preferred)

Work Location:

In person