Nurse Consultant

Prioritize and manage an assigned caseload of medical and disability workers compensation claims Perform utilization review (UR) and telephonic case management as indicated Communicate with injured employees, medical professionals, claims staff and employers to obtain information for medical assessments Assess injury severity, disability, treatment plans, functional abilities and physical job requirements Establish target return-to-work plans and strategies to manage future medical exposure Direct treatment to appropriate panel and network providers Negotiate treatment plans in compliance with Labor Code statutes and company standards Manage external field case managers, vendors, UR/peer review and medical director resources Respond to written and telephone inquiries regarding case status Document interventions, rationale and recommendations in the Zenith system Facilitate appropriate return-to-work release and coordinate return-to-work efforts Facilitate Maximum Medical Improvement and discharge from care Educate claims staff, employers and Zenith staff on medical issues and guidelines Perform other duties and projects as assigned Requirements High School Diploma or equivalent combination of education and experience required Bachelor's Degree or equivalent combination of education and experience 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 3+ years of experience Pursues continuing education related to RN licensure and certification, workers' compensation and utilization review practices 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 Good negotiation skills Proficient in basic computer skills, especially Microsoft Outlook and Office Comfortable in a professional business environment Valid Driver's License in good standing Bilingual Spanish a plus Core Competencies Demonstrates expertise in managing medical and disability workers compensation claims, including utilization review and telephonic case management. Proficient in assessing injury severity and developing return-to-work plans while ensuring compliance with Labor Code statutes. Highest-signal resume keywords Registered Nurse (R.N.) License Utilization Review (UR) Workers Compensation Claims Management Negotiation Skills Clinical Practice in Orthopedics or Neurology Hard Skills Utilization Review Case Management Injury Assessment Treatment Plan Development Return-to-Work Planning Documentation in Zenith System Clinical Practice Medical Assessment Compliance with Labor Code Telephonic Communication Soft Skills Strong Written Communication Strong Verbal Communication Good Negotiation Skills Certifications & Qualifications Registered Nurse (R.N.) License CCM CDMS CIRS CRRN COHN Industry Keywords Workers Compensation Utilization Review Practices Medical Professionals Communication Return-to-Work Strategies, Maximum Medical Improvement Tools & Technologies Microsoft Outlook Microsoft Office #J-18808-Ljbffr Jobtailor