[Hiring] Field Nurse Consultant Workers' Compensation @Zenith Insurance Company

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Role Description This role involves managing a caseload of medical and disability workers compensation claims according to Zenith guidelines. • Conduct in-person and telephonic assessments of injured workers to evaluate injury status, treatment progress, functional capacity, and barriers to recovery. • Attend medical appointments as needed to facilitate communication between providers, injured workers, and claims stakeholders. • Review medical records, diagnostic studies, and treatment plans to assess appropriateness, progress, and consistency with evidence-based guidelines. • Identify treatment delays, non-adherence, psychosocial risk factors, and other obstacles impacting recovery. • This is a remote role with a preferred location around the Fresno, Salinas, Monterey, and Modesto area in California. • The selected candidate will be provided with a company car for travel. Responsibilities • 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. • Work productively and harmoniously with others on a consistent basis. • Respond positively to direction and feedback on performance. • Consistently maintain professional and appropriate demeanor. • Perform other duties/projects as assigned. Qualifications • Regular and reliable attendance is required; must be able to work at least 37.5 hours per week, Monday through Friday, and be available for extended hours as situations arise. • Position may require extensive travel and remote working conditions, or overnight travel. • Must be available to work catastrophes (CAT) requiring travel to CAT sites with varied claims responsibilities and for extended periods of time beyond the typical work week. Education • Must be a Registered Nurse or similar. • High School Diploma or equivalent combination of education and experience required. • Bachelor’s Degree or equivalent combination of education and experience preferred. • Certified Case Manager (CCM) certification is a plus. Work Experience • 3+ years of experience maintaining a current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law. Knowledge, 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. Pay, Benefits, and Other Information • The expected salary range for this position is $85,736.31 - $105,000. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. • Medical, Dental and Vision Insurance. • Flexible Spending Accounts. • Paid Parental Leave. • Life, AD&D and Disability Insurance. • 401(k), Employee Share Purchase Plan (ESPP). • Education and Training Reimbursement. • Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave. • 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays. • Employee Assistance Program (EAP). Apply tot his job Apply To this Job