Workers' Compensation Nurse Case Manager

Job Title

Workers' Compensation Nurse Case Manager (260002W9)

Overview

The Commonwealth of Massachusetts Executive Department is one of the state's largest employers with over 46,000 employees that span 11 Secretariats and 70 plus agencies. From accountants to X‑ray technicians with hundreds of titles in between, we are one employer with many career opportunities. The Commonwealth is looking for leaders, thinkers, creators, and innovators.

We are a diverse workforce that reflects the diverse population that we serve.

The Human Resources Division (HRD) is an agency within the Executive Office for Administration and Finance. HRD provides support to state agencies in all matters relating to classification, compensation, benefits, recruitment, training, employee development, civil rights, collective bargaining and workers’ compensation administration. The mission of HRD is to attract, develop and retain a high performing workforce in order to ensure the delivery of constituent services across the Commonwealth.

The Human Resources Division/Workers’ Compensation Unit (HRD/WC) is the legislatively authorized administrator of the Commonwealth’s self‑insured workers’ compensation program. HRD/WC uses a medical management strategy to facilitate the employee’s recovery and return to work. The goal of HRD/WC is to return injured employees to gainful employment in a timely, efficient way.

Job Details

Agency: Human Resources Division

Location: Primary Location

Schedule: Full-time

Shift: Day

Official Title: Registered Nurse III

Number of Openings: 1

Salary: 90,304.24 - 150,686.38 Yearly

Potentially Eligible for a Hybrid Work Schedule: Yes

Confidential: Yes

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 for 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.

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 a 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 have the ability to give oral instructions in a 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.

First consideration will be given to those applicants that apply within the first 14 days.

Minimum Entrance Requirements

Applicants must have at least one year of full-time or equivalent part‑time experience as a registered nurse in a recognized hospital, clinic or medical facility, and six months of which must have been in a supervisory, administrative or managerial capacity.

Special Requirements

Current and valid registration as a professional nurse under the Massachusetts Board of Registration in Nursing is required. Recent graduates from an approved school of nursing must have applied for the first available registered nurse examination. Based on assignment, possession of a current and valid Massachusetts Motor Vehicle Operator’s license may be required.

Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Equal Opportunity

An Equal Opportunity / affirmative action employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

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. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Questions or need a reasonable accommodation? Please contact Diversity Officer / ADA Coordinator: Pete Murillo – 617‑878‑9700.