Workers' Compensation Nurse Case Manager

Job Title Workers' Compensation Nurse Case Manager (Registered Nurse III) Overview The Commonwealth of Massachusetts Executive Department, one of the state’s largest employers with over 46,000 employees, is seeking a Telephonic Nurse Case Manager to provide early intervention to injured Commonwealth employees through telephonic support. The role involves ongoing contact with medical treatment providers, injured workers, and adjusters to facilitate the delivery of appropriate medical treatment, promoting a safe and timely return to work. Note This position requires the selected candidate to be a Registered Nurse (RN) licensed in the Commonwealth of Massachusetts. Responsibilities Review referral with claims adjuster to identify any issues, review treatment plan and options available to assist the injured worker to reach MMI and re‑enter the workforce. Initiate and maintain telephone contact with the injured worker and treating providers as needed during the period of treatment, including phone check‑ins following office visits. Request/review office notes and Work Capacity Forms from treating physician. Document/record all communication in eCompManager within 24‑hours of action. Maintain a claim diary to keep deadlines and action plan for future handling. Discuss discrepancies in treatment plans with adjuster. Maintain a directory of physicians that accept MA IAB Rates and surgical fees. Act as a point of reference regarding medical issues. Recommend outsourcing catastrophic cases to on‑site case management when necessary. Document/discuss findings with HRD adjuster and management as needed (i.e., catastrophic claims). Facilitate a positive relationship between the injured worker, adjuster and partner agency. Facilitate/coordinate return to work – full/modified duty. Review reporting of opioid utilization via pharmacy benefit management program and identify cases where additional review or active case management is required. Work with WC Management and PBM to provide outreach to treating physicians who are prescribing high MME's (morphine milligram equivalent) to injured workers. Work with WC Management and adjusters to coordinate review of complex medical requests/files. Develop relationships with providers to facilitate ease of communication between HRD/WC. Assistants to Adjusters Assist adjusters and operational staff as needed on issues with UR vendor. Preferred Qualifications At least three years of full‑time, or equivalent part‑time, experience as a registered nurse in a clinical setting such as recognized hospital, clinic or medical facility. At least two years nursing case management experience. Composure to work in stressful situations, maintain a calm demeanor, utilize sound judgment, make decisions and recommendations. Excellent written and verbal skills, communicate clearly and concisely and the ability to give oral instructions in precise and understandable manner. Ability to review observations and data, draw conclusions and make appropriate recommendations. Ability to work with minimal supervision and direction. Commitment to working in a team environment. Knowledge of standard nursing policies, procedures, methods, and techniques. Minimum Entrance Requirements Applicants must have at least (A) one year of full‑time or equivalent part‑time, experience as a registered nurse in a recognized hospital, clinic or medical facility, and (B) six months of which must have been in a supervisory, administrative or managerial capacity. Special Requirements for All Levels in Series Current and valid registration as a professional nurse under the Massachusetts Board of Registration in Nursing. Recent graduates from an approved school of nursing must have applied for the first available registered nurse examination. First Consideration Note First consideration will be given to those applicants that apply within the first 14 days. Salary & Benefits Salary range: $90,304.24 – $150,686.38 annually. Employees receive an outstanding suite of benefits that add to the overall value of the compensation package, supporting employees, their loved ones, and their future. EEO Statement The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. The Commonwealth encourages individuals who believe they have the necessary skills to thrive in this role to apply. Contact for EEO Questions Diversity Officer / ADA Coordinator: Pete Murillo, View phone number on click.appcast.io. #J-18808-Ljbffr