Job Summary:
The Employee Health and Wellness Case Manager is responsible for coordinating the management of claims under the worker’s compensation and short term disability programs and minimizing liabilities resulting from those claims for The Valley Health System. Demonstrates strong nursing competencies, case management expertise and knowledge of occupational health practices, OSHA, Workers' Compensation and short term disability regulations.
Competencies:
Coordinates worker’s compensation and disability cases by working with employees, management, health care providers and insurance companies in order to ensure proper processing of claims, approve payment of benefits and a safe and timely return to work.
Supports return to work programs by identifying alternate temporary duties specified by the employee's treating physician. Identifies and discusses availability of work assignments and specific conditions of the employee's return to work conditions with management, human resources representatives and treating physicians.
Focuses on influencing medical care by intervening with the physician to achieve maximum medical improvement and to minimize permanent disability.
Assures compliance with policy and procedures as they apply to the disability programs and in the management of employee work related injuries and disabling health conditions.
Coordinates information dissemination and provide explanation of insurance programs, benefits and state and federal laws associated with disability to employee and management. Will collaborate with Leave Specialist so applicable regulations are appropriately applied.
Pursue all claim resolution opportunities, which most effectively manage claim costs (i.e. investigation, medical management, return to work, review for questionable indicators). Arrange specialist appointments with physicians when deemed necessary. Use Disability duration guidelines to minimize the duration of absence, maintain and report on metrics dashboard monthly.
Reviews all claims for reasonable and necessary medical care/costs.
Maintains required professional competencies and licensure and certification requirements.
On a staffing relief basis, provides occupational health nursing services to employees, prospective employees and volunteers in a variety of age groups by performing varied occupational health functions in accordance with licensure, certification, training and regulatory requirements.
Ensures clinic and medical record confidentiality.
Accurately enters, updates and audits one’s own API clocking transactions (time card) including benefit time. (EE: 0-3 Correction Forms submitted, AE: 4-6 Correction Forms submitted, NI: 7 or more Correction Forms submitted.)
Performs other duties as required and/or requested based on the needs of the patient, department and organization.
Education:
Registered Nurse. Licensed in State of New Jersey. Graduate from an accredited School of Nursing with a Bachelor`s Degree in Nursing or graduate from an accredited School of Nursing with a Bachelor`s Degree in a healthcare related field. Certification in Case Management. Evidence of continuing professional education.
Experience:
Minimum five years experience as a nurse case manager. Experience in occupational health nursing preferred.
OSHA:
Bloodborne Pathogen Category I
Employees in this job description are expected to have contact with bloodborne pathogens and as such they are required to be oriented and annually trained under the Federal Occupational Safety and Health Administration's Bloodborne Pathogen Standard (CFR 1910.1030)
Annual N95 Respirator Fit Testing required.
Special Skills:
Demonstrates personable and responsive interaction and strong communications skills (oral, written and presentation) while working within the department, healthcare system and varied populations. Demonstrates a positive professional approach and attitude at all times and is able to adjust to changing work processes. Must be detailed oriented and utilize effective time management to set priorities and perform job related responsibilities. Able to use critical thinking and clinical reasoning skills to problem solve and provide case management services. Able to function competently in stressful situations and changing work environments related to changing needs of employees. Must be able to travel to other hospital locations if needed.
Must be proficient in Microsoft Office programs: Word, Excel and Email.
CPR (BLS) and AED certification, venipuncture skills required.
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