Workers Compensation Nurse Case Manager

Job ID: J128344
Company: Allegheny Clinic
Location: Pittsburgh, PA, United States
Facility: Federal North Building
Full/Part Time: Full time
Job Type: Regular
Posted at: Dec 6, 2018

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Description

GENERAL OVERVIEW:

This individual will coordinate and manage the AHN Workers Compensation Program, serving as the liaison between all parties involved in the Workers Compensation claim, including the injured worker, physicians, the insurance company, Employee Health, Human Resources, and Quality Safety Value teams. Will assist with coordination of care to expedite necessary medical treatment, conduct ongoing review and management of claims, and facilitate timely return to work to ensure injury/claim resolution.               

ESSENTIAL RESPONSIBILITIES:

  • Evaluate all injury claims, coordinate/delegate accident investigations to determine root cause of injury, identify opportunities for workplace safety improvements, and facilitate timely medical treatment, as applicable. (30%)
  • Initiate contact with injured employee, Workers Compensation Insurance Carrier and Employee Health, identifying timely actions and interventions needed. (20%)
  • Proactively manage all active claims to assess progress/response to treatment, prevent lapses or delays in treatment, obtain regular updates on work status and facilitate employees' return to work in conjunction with leaders and Human Resources. (20%)
  • Collaborate and maintain regular communication with Employee Health nurses, Medical Director, and other key stakeholders. (15%)
  • Participate in weekly claims reviews with Insurance Carrier, Employee Health and Human Resources. (10%)
  • Performs other duties as assigned or required. (5%)

QUALIFICATIONS:

Minimum

  • Associate’s degree in Nursing
  • 5-7 years worker’s compensation case management experience
  • 5-7 years experience as a Registered Nurse
  • Current RN Licensure
  • Travel required between Hospitals

Preferred

Compliance Requirement: As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

  • Commission for Case Manager Certification (CCMC)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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