RN Workers Comp Coordinator

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

CHI Health has an immediate need to add a Workers Comp Coordinator (RN / Nurse) to our Orthopedic clinic located at our Lakeside campus off of 168th & Center! 

Hours: Monday-Friday 8a-5p, NO weekends, NO holidays & NO call! 

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance 
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft 
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO) 
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
  
• Flexible spending accounts

Job Summary: 

Manage the Workers' Compensation programs for CHI Health Orthopedics which includes coordinating care for Workers' Compensation patients. Serves as a liaison between healthcare personnel, nurse case managers, rehabilitation professionals, personnel representatives, claims adjusters, attorneys, and patients for individuals who are disabled due to an injury or illness. Assists in the medical and legal aspects of Workers' Compensation working with claims adjusters, nurse case managers, and attorneys. Meets with companies, nurse case managers, and insurance adjusters to expand the business of CHI Health Orthopedics.

Job Responsiblities: 

• Screen telephone calls for Workers' Compensation new appointments to include gathering demographic data, obtaining prior medical records and verifying insurance coverage for the scheduled appointment.
• Obtains approval or authorization for additional testing and surgical procedures by working with nurse case managers and insurance claims adjusters. Obtain approval by the Work Comp insurance carriers of all WC surgeries that are performed by the surgeons in our department. (Upon receiving the written authorization for the procedure it will be given to the medical provider's surgery scheduler who will schedule the approved procedure.)
• Facilitates collection of pertinent patient medical records with a summary letter from the assigned nurse case manager or insurance claims adjuster to forward to the appropriate orthopedic surgeon for review of a second opinion. Obtain the x-ray and MRI CD's on medical records requests and send to the requesting party.
• Prepare and maintain a tracking system for outstanding charges and pre-payment charges for narrative reports, record reviews, and etc. for Workers' Compensation and personal injury patients.
• Communicate with nurse case managers, insurance claims adjusters, and human resource personnel to ensure that all information (dictation, work restriction releases, etc.) for Workers' Compensation patients are received in a timely fashion.
• Conduct random audits of the orthopedic surgeons' dictation and ensure that the dictation is copied and faxed to the appropriate nurse case manager, insurance claims adjuster, and/or human resource personnel for Workers' Compensation patients.
• Network with outside companies, nurse case managers and insurance claims adjusters to offer CHI Health Orthopedics as their source of orthopedic medical care.
• Assist business office personnel in the collection of difficult or complicated Workers' Compensation or personal injury accounts.
• Conduct in-service programs (in conjunction with the orthopedic surgeons') for nurse case managers, insurance claims adjusters, and human resource personnel as necessary.
• Ensure the confidentiality, integrity, and availability of protected health information the company creates, receives, maintains, and transmits. Must maintain the confidentiality of patient and company confidential information as required by the company policy and HIPPA regulations.
• Act as a triage nurse for incoming patient calls.
• Participate as an active member of the Workers' Compensation Association of Nebraska representing CHI Orthopedics and have a marketing table that I man at the annual 2 day conference in Lincoln, NE to network with vendors of WC insurance carriers, WC claims adjusters, RN Case Managers, HR Managers and Safety Managers for employers and attorneys etc.).
• Schedule all depositions and telephone conference calls with attorneys and the treating surgeon in our department for all WC injuries, MVA injuries and personal injuries once the med/legal invoice that I have generated has been paid by the insurance carrier or the attorney. Complete the med/legal invoices for the surgeons in our department for med/legal reports that are to be completed by the treating surgeon in our department.
• Assist CHI HR Coordinator and Sedgwick WC claims adjusters with CHI employees with WC injuries/illnesses who are treating with our providers for timely return to work and authorization of recommended treatment plans.
• Assist CHI Quality and Risk Management when telephone calls are received from Law Firms and the subpoenaed medical records have not been received as requested by the subpoena Submit all subpoenas received by our department to the subpoena email site to follow the legal request process for CHI Health Clinics.

Minimum Qualifications: 

• Graduate of an accredited school of Licensed Nursing
• Current RN license from the state of Nebraska
• Basic Life Support (BLS) from the American Heart Association strongly preferred
• Experience in occupational health and/or care management preferred
• Knowledge of Workers' Compensation rules and regulations
• Knowledge of medical office operating policies and patient account policies and practices in the medical office