NURSE CASE MANAGER - WORKERS COMP (FT)

The Workers Compensation Nurse Case Manager at Riverside Healthcare plays a critical role in managing and coordinating care for employees who have sustained work-related injuries or illnesses. This role involves overseeing the entire workers' compensation process, from initial injury treatment through return-to-work planning. As a liaison among all parties involvedincluding doctors, therapists, the injured worker, the employer, and the insurance companythe Nurse Case Manager ensures effective treatment, timely resolution of claims, and adherence to workers' compensation regulations. The Nurse Case Manager will leverage clinical expertise to address any issues related to care and facilitate optimal outcomes for both the employee and the organization.

FTE & Shift: 1.0 FTE (Full-Time) | Days (8:30AM to 5:00PM)

Essential Duties

• Coordination and Case Management:
• Obtain and manage all workers compensation patient claim information, including insurance details, claims adjustor contact, claim number, and status.
• Act as a liaison between patients, healthcare providers, employers, and insurance companies to ensure prompt and effective treatment of injuries.
• Communicate the patient's ongoing injury treatment status to all affected parties.
• Ensure all services, treatments, referrals, and procedures are authorized, scheduled, and completed in a timely manner.
• Patient Care and Follow-Up:
• Monitor patient progress from initial injury treatment through resolution or discharge, maintaining ongoing files and updating documentation daily in occupational health software.
• Ensure timely dissemination of updated records, progress reports, testing documentation, and lab results.
• Coordinate care with providers, oversee specialist appointments, and ensure recommendations are implemented.
• Administrative and Compliance Duties:
• Assist in the preparation of appeals for insurance denials for injury treatments and procedures.
• Complete insurance forms, FMLA forms, and disability forms as requested by patients.
• Obtain required authorizations for testing and treatment ordered by providers.
• Maintain professionalism and handle administrative tasks as directed, including protocol and process implementation.
• On-Call and Additional Responsibilities:
• Participate in the weekly on-call schedule and assist with patient care during staffing shortages or high-volume periods, including rooming patients, performing drug screens, N95 fit tests, and breath alcohol testing.
• Provide education to injured workers and clients regarding workers' compensation and safe work practices.
• Quality Improvement and Education:
• Proactively manage active claims to prevent lapses or delays in treatment, and facilitate the injured workers timely return to work.
• Identify clients with high injury rates and work with them to promote safe work practices.
• Maintain knowledge of current literature, OSHA guidelines, and workers' compensation laws and regulations.

Non-essential Duties

•  Assist with protocol and process implementation as needed.
•  Contribute to departmental projects and other duties as assigned.

Required Experience

• Successful completion of a practical nursing program or graduation from a school of nursing

Preferred Experience

• A minimum of three years of experience in case management for occupational health.

Required Licensure/Education

• Registered Nurse (RN) license in the state of Illinois, or Licensed Practical Nurse (LPN) with certification.
• Current CPR certification.

Preferred Education

• DOT and Drug Screen Certifications preferred or willingness to obtain.
• MRO Assistant certificate preferred or willingness to obtain.
• DOT certified train-the-trainer certificate preferred or willingness to obtain
• Skills:
• Excellent verbal, written, and communication skills.
• Strong attention to detail and organizational skills.
• Ability to coordinate care among multiple parties and educate staff and patients.
• Proficient in making knowledgeable clinical assessments and working independently as well as collaboratively.
• Ability to work as a team member and assist with patient care when needed.
• Knowledge of current literature in workers' compensation and occupational health.
• Understanding of OSHA guidelines and recommendations.

Employee Health Requirements

Exposure/Sensory Requirements

Exposure to: 

• Chemicals: Refer to MSDS Sheets 
• Video Display Terminals: Average 
• Blood and Body Fluids: Obtaining and transporting patients' body fluids. 
• TB or Airborne Pathogens: Minimal - Exposure potential reduced through the use of universal precautions. 

Sensory requirements (speech, vision, smell, hearing, touch): 

• Speech: Needed for communication with patients, other staff and outside companies 
• Vision: Needed to read materials such as medical records. 
• Smell: Needed to detect the odor gas or electrical hazards. 
• Hearing: Required for patient safety, telephone use, and vital signs. 
• Touch: Required for pulse taking, supportive/comforting interventions and control.

Percentage of time during the normal workday the employee is required to:

• Sit: 70% 
• Twist: 3% 
• Stand: 10% 
• Crawl: 0% 
• Walk: 30% 
• Kneel: 1% 
• Lift: 1% 
• Drive: 0% 
• Squat: 1% 
• Climb: 0% 
• Bend: 1% 
• Reach above shoulders: 1% 

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently 
• Up to 20 lbs: Not Required 
• Up to 35 lbs: Not Required 
• Up to 50 lbs: Not Required 
• Up to 75 lbs: Not Required 
• Up to 100 lbs: Not Required 
• Over 100 lbs: Not Required 

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Putting away supplies. Lift above the head occasionally to place boxes on high storage shelves. Carry boxes up and down the stairs - distances up to 100 feet.

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 378 
• Twist: 0 
• Stand: 54 
• Crawl: 0 
• Walk: 162 
• Kneel: 5.4 
• Lift: 5.4 
• Drive: 0 
• Squat: 5.4 
• Climb: 0 
• Bend: 5.4 
• Reach above shoulders: 5.4 

Repetitive use of hands (Frequency indicated): 

• Simple grasp up to 10 lbs. Normal weight occasional 
• Pushing &pulling Normal weight occasional 
• Fine Manipulation: Writing, use of computer keyboard, telephone use, push patient in wheelchair. 

Repetitive use of foot or feet in operating machine control: None 

Environmental Factors &Special Hazards

• Environmental Factors (Time Spent): 
• Inside hours: 8 
• Outside hours : 0 
• Temperature: Normal Range 
• Lighting: Average 
• Noise levels: Average 
• Humidity: Normal Range 
• Atmosphere: 
• Special Hazards: NA 
• Protective Clothing Required: None