**All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid Time Off from Day One + Career Development + Whole Person Wellbeing Resources + Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Full Time **Shift** : Monday Friday **Location:** Remote **The role youll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management for Workers Compensation Injury cases. Case Management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual injured workers health needs through communication and available resources to promote quality cost-effective outcomes. This process enhances the physical, psycho-social, and vocational health of individuals. The goal of the Telephonic Case Manager is to assist the injured worker in receiving appropriate, cost-effective medical care for their injury in the most timely and compassionate manner possible, according to jurisdictional guidelines, in order to expedite their successful return to work. **The value youll bring to the team:** + Provide telephonic case management for multi-state claim caseload assignment (excluding GA: written consent required, and NC: must be registered rehab nurse with NCIC) + Reports directly to the WC Medical Case Manager for assignments and supervision. + Demonstrate mastery of the nursing process (assess, plan, implement, coordinate, monitor and evaluate) in accordance with established national standards for case management activities + Complete two-point initial contacts process within 48 hours upon receiving TCM referral. Two-point contact includes conducting a comprehensive assessment via a telephonic interview with the injured employee to gather information about the injury, medical treatment and workplace role and environment as well as a personal medical and surgical history and contacting the medical provider(s) to obtain/confirm diagnosis, work restrictions and treatment plans and reports to Clinical Director any claims that need immediate FCM. + Develop a comprehensive medical treatment plan based on data collected through telephonic medical interview, assessment and review of medical documentation that ensures appropriate and timely treatment from approved providers. Estimated length of disability is defined and monitored. + Identify files that are appropriate for FCM referral and involvement. + Complete therapy and diagnostic referrals within AdventHealth system, following for attendance, progress and achievement of goals being met. Assessing when necessary to refer outside of AdventHealth when optimal for recovery and compliance + Refer DME requests to approved vendors, negotiating best prices when able, follow up for prompt delivery and confirm receipt by the injured employee + Arrange transportation/translation services when necessary and authorized + Provide telephonic education and support to the injured worker helping them understand their diagnosis, treatment and rehab plan along with timeframes and expectations for recovery per evidence-based guidelines + Monitor medical services for appropriateness of causally related diagnosis and treatment plan, adjusting strategies and coordinating additional services as necessary + Address pre-existing medical conditions by assisting with obtaining and providing prior personal medical records to providers when appropriate in order to address causation. + Draft professional correspondence/letters for causation inquiries, treatment clarification and Independent Medical Examinations + Monitor the injured employees medical progress by maintaining regular contact with providers, obtaining medical reports and updating case files accordingly + Identify barriers to recovery and identify plans to mitigate barriers to achieve objectives and support the injured worker through the recovery process. + Collaborate with healthcare providers and the injured worker to develop and implement return-to-work plans that facilitate early and safe return to work as per AdventHealths twelve-week transitional duty program + Participate in formal roundtable discussions on claim progress with clinical director and claims adjuster and legal representative (if applicable) to draft action plan to address and achieve new goals + Collaborate and communicate on file direction and claim progress as needed with clinical director and claims adjuster to reach claim goals and objectives, assessing and reassessing throughout the life of the claim to facilitate seamless case management and decision-making + Address medication usage, appropriateness, medication reconciliation, safety, duration and mitigate concerns using available tools such as professional inquiry letters, peer review or UR where appropriate + Address treatment requests with complexities of causation or medical necessity by securing Independent Medical Examinations or submitting formal Utilization Review with clinical director and claims adjuster approval and within required jurisdictional timeframes + Document case notes, treatment plans, and communications in Origami using appropriate note type and in timely manner + Evaluate treatment plans ensuring that care is appropriate and medically necessary and consistent with evidence-based guidelines and regulatory requirements + Ensure compliance with state and federal workers compensation laws, as well as company policies and procedures. + Stay updated on best practices in occupational health and workers compensation management through ongoing education and professional development. + Handle all medical information and reports as confidential information + Work closely with legal teams as applicable to provide medical information and support in cases involving litigation ensuring compliance with legal requirements + Attending in-service meetings and continuing education seminars, as appropriate + Utilize effective oral communication, written communication and organization skills and demonstrates the ability to prioritize case activities + Other duties as assigned Qualifications **The expertise and experiences youll need to succeed** **:** **EDUCATION AND EXPERIENCE REQUIRED** **:** + Bachelors degree in nursing (BSN) preferred. + Minimum of 2 years of clinical nursing experience, preferably in occupational health, case management, or a related field such as orthopedic, neurological, rehabilitation, med/surg + Experience in workers compensation case management is highly desirable. + Strong understanding of injury management, treatment protocols in relation to workers compensation cases. + Knowledge of common workplace injuries and rehabilitation is essential **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:** + Active Registered Nurse (RN) license in the state of practice. Willing to secure COMPACT nursing license immediately upon hire + Certified Case Manager (CCM) or Certified Rehabilitation Registered Nurse (CRRN) preferred. If does not possess, willing to obtain CCM within 2 years of employment + Experience in case management, workers' compensation or liability experience highly preferred + Experience in field case mgmt, home health, occupational health, considered a plus This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. **Category:** Nursing **Organization:** AdventHealth Corporate **Schedule:** Full-time **Shift:** 1 - Day **Req ID:** 25025152 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.