Workers' Compensation Nurse Case Manager

The Commonwealth of Massachusetts Executive Department is one of the state's largest employers with over 46,000 employees that span 11 Secretariats and 70 plus agencies. From Accountants to X-ray technicians with hundreds of titles in between, we are one employer with many career opportunities. The Commonwealth is looking for leaders, thinkers, creators, and innovators. We are a diverse workforce that reflects the diverse population that we serve.

Agency Description

The Human Resources Division (HRD) is an agency within the Executive Office for Administration and Finance. HRD provides support to state agencies in all matters relating to the Commonwealth's classification, compensation, benefits, recruitment, training & employee development, civil rights, collective bargaining and workers’ compensation administration.

The mission of the Human Resources Division (HRD) is to attract, develop and retain a high performing workforce in order to ensure the delivery of constituent services across the Commonwealth.

About the Workers’ Compensation Unit

The Human Resources Division/Workers’ Compensation Unit (HRD/WC) is the legislatively authorized administrator of the Commonwealth’s self-insured workers’ compensation program. HRD/WC uses a medical management strategy to facilitate the employee’s recovery and return to work. It is the goal of HRD/WC to return injured employees to gainful employment in a timely, efficient way.

Position Summary

The HRD/WC Telephonic Nurse Case Manager provides early intervention to injured Commonwealth employees via telephonic support. The Telephonic Nurse Case Manager will have ongoing contact with medical treatment providers, injured workers and adjusters to facilitate the delivery of appropriate medical treatment for injured workers, with the goal of a safe, timely return to work.

Please note (requirement): This position requires the selected candidate to be a Registered Nurse (RN) licensed in the Commonwealth of Massachusetts.

Responsibilities include, but are not limited to the following:

• Review referral with claims adjuster to identify any issues, review treatment plan and options available to assist the injured worker to reach MMI and re-enter the workforce.
• Initiate and maintain telephone contact with the injured worker and treating providers as needed during the period of treatment, including phone check-ins following office visits.
• Request/review of office notes and Work Capacity Forms from treating physician.
• Document/record all communication in eCompManager within 24-hours of action.
• Maintain a claim diary to keep deadlines and action plan for future handling.
• Discuss discrepancies in treatment plans with adjuster.
• Maintain a directory of physicians that accept MA IAB Rates and surgical fees.
• Act as a point of reference regarding medical issues.
• Recommend outsourcing catastrophic cases to on-site case management when necessary.
• Document/discuss findings with HRD adjuster and management as needed i.e., catastrophic claims.
• Facilitate a positive relationship between the injured worker, adjuster and partner agency.
• Facilitate/coordinate return to work – full/modified duty.
• Review reporting of opioid utilization via pharmacy benefit management program and identify cases where additional review or active case management is required.
• Work with WC Management and PBM to provide outreach to treating physicians who are prescribing high MME's (morphine milligram equivalent) to injured workers.
• Work with WC Management and adjusters to coordinate review of complex medical requests/files.
• Develop relationships with providers to facilitate ease of communication between HRD/WC.
• Assist adjusters and operational staff as needed on issues with UR vendor.

Preferred Qualifications:

• At least three years of full-time, or equivalent part-time, experience as a registered nurse in a clinical setting such as recognized hospital, clinic or medical facility.
• At least two years nursing case management experience.
• Composure to work in stressful situations, maintain a calm demeanor, utilize sound judgment, make decisions and recommendations.
• Excellent written and verbal skills, communicate clearly and concisely and the ability to give oral instructions in precise and understandable manner.
• Ability to review observations and data, draw conclusions and make appropriate recommendations.
• Ability to work with minimal supervision and direction.
• Commitment to working in a team environment.
• Knowledge of standard nursing policies, procedures, methods, and techniques.