RN Full-time
Commonwealth of Massachusetts

Workers' Compensation Nurse Case Manager

Commonwealth of Massachusetts Boston, MA, US
$90,304.24 - $150,686.38 / year

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 Descriptio

nThe 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 Commonwealt


h.
About the Workers’ Compensation U

nitThe 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 w


ay.
Position Sum

maryThe 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 w


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


etts.
Responsibilities include, but are not limited to the foll

  • owing: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 work
  • force.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 v
  • isits.Request/review of office notes and Work Capacity Forms from treating phys
  • ician.Document/record all communication in eCompManager within 24-hours of a
  • ction.Maintain a claim diary to keep deadlines and action plan for future han
  • dling.Discuss discrepancies in treatment plans with adj
  • uster.Maintain a directory of physicians that accept MA IAB Rates and surgical
  • fees.Act as a point of reference regarding medical i
  • ssues.Recommend outsourcing catastrophic cases to on-site case management when nece
  • ssary.Document/discuss findings with HRD adjuster and management as needed i.e., catastrophic c
  • laims.Facilitate a positive relationship between the injured worker, adjuster and partner a
  • gency.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 req
  • uired.Work with WC Management and PBM to provide outreach to treating physicians who are prescribing high MME's (morphine milligram equivalent) to injured wo
  • rkers.Work with WC Management and adjusters to coordinate review of complex medical requests/
  • files.Develop relationships with providers to facilitate ease of communication between H
  • RD/WC.Assist adjusters and operational staff as needed on issues with UR v


endor.
Preferred Qualific

  • ations: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 fa
  • cility.At least two years nursing case management expe
  • rience.Composure to work in stressful situations, maintain a calm demeanor, utilize sound judgment, make decisions and recommend
  • ations.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 recommend
  • ations.Ability to work with minimal supervision and dir
  • ection.Commitment to working in a team envir
  • onment.Knowledge of standard nursing policies, procedures, methods, and tech


niques.

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