$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 (requirem ent): 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. 
