Nurse Medical Case Manager - Workers' Compensation

*PLEASE NOTE*
Flexible Hybrid - Candidate must be able to go into office one day per week
Prioritize and manage an assigned caseload of medical and disability workers compensation claims according to Zenith guidelines, performing UR and telephonic case management, as indicated.

• Communicate with injured employees, medical professionals, claims staff and employers timely and regularly to obtain information necessary to make sound medical assessments regarding diagnosis and prognosis.
• Assess injury severity, extent of disability, treatment plans, functional abilities and physical job requirements to establish target return to work plans and/or strategy to manage future medical exposure.
• Direct treatment to appropriate panel and network providers, effectively negotiating treatment plans in compliance with Labor Code statutes and company standards.
• Utilize and manage resources appropriately, including external field Case Managers, vendors, UR/peer review, and medical director.
• Respond to various written and telephone inquiries timely regarding status of case.
• Consistently and accurately document interventions, rationale and recommendations in the Zenith system, utilizing the appropriate templates, and following Zenith guidelines, as indicated.
• Facilitate earliest appropriate return to work release and coordinate return to work efforts with all parties, as appropriate.
• Facilitate Maximum Medical Improvement and discharge from care.
• Educate claims staff, employers and other Zenith staff on medical issues/guidelines, within corporate guidelines.

Education Qualifications

• High School Diploma or equivalent combination of education and experience required
• Bachelor's Degree or equivalent combination of education and experience preferred

Experience Qualifications

• 3+ Years Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law. required

Skills and Abilities

• Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to Workers' Compensation and utilization review practices.,
• 3 years recent experience working remotely either in a telephonic or field case management role with a preference in Workers' Compensation.,
• 3 to 5 years clinical practice with experience in orthopedics, neurology, or occupational medicine preferred.,
• Possesses or pursues additional professional certifications; such as CCM, CDMS, CIRS, CRRN or COHN.,
• Strong written and verbal communication skills in order to effectively communicate with injured employees, medical professionals, employers, claims staff and others.,
• Good negotiation skills to successfully establish target return to work dates and manage medical and disability treatment plans.,
• Proficient in basic computer skills, especially Microsoft Outlook and Office.
• Comfortable in a professional business environment.
• Bilingual Spanish a plus.
• Valid Driver's License in good standing.

The expected salary range for this position is $81,834.55 to $102,293.19 . Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law.
Qualifications may warrant placement in a different job level.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Zenith Insurance Company.
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