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Zenith Insurance Company
RN MEDICAL MANGEMENT NURSE - WORKERS COMPENSATION
Los Angeles, CA 91367 United States
The essential functions of this position include, but are not limited to, the following:
Prioritize and manage an assigned caseload of medical and disability workers' compensation claims according to Zenith guidelines, performing UR and telephonic case management, as indicated.
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.
Education, training, experience:
Education, Skills and Experience Requirements
Degree from an accredited nursing school required, with Bachelor of Science in nursing preferred.
Maintain current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
Valid Driver’s License in good standing.
Pursues continuing education as it pertains to maintaining RN licensure and certification, relating to workers’ compensation and utilization review practices.
3 years experience with a preference for previous insurance nurse case management/utilization review (or equivalent prior experience), preferably in workers’ compensation.
1 year clinical experience required. Minimum 3 years preferred with 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.
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