Overview
Description
Job Summary
The Nurse Specialist is responsible for utilizing their nursing knowledge and clinical judgement in reviewing all client employee examinations, testing, and questionnaires, in consultation with WorkCare Physicians, ensuring compliance with regulatory requirements, company policies, and industry standards to determine employee’s ability to perform essential job functions. Additionally, this role also involves providing nursing support activities/services for case management and return to work programs.
Essential Duties and Responsibilities
Exam Review
Provide professional nursing review of occupational health records for client employee medical surveillance exams, laboratory test results, health questionnaires and medication review as determined by client to determine if employee is cleared to work
Maintain detailed and accurate records of all reviews and actions taken
Escalate cases as needed to WorkCare Physician for review, guidance/recommendations and clearance
Identify potential health concerns, inconsistencies, or missing information and take appropriate follow-up actions
Collaborate with client to clarify medical documentation and testing requirements as needed
Provide guidance to employees regarding additional tests or follow-ups needed
Respond to client and employee inquiries professionally and promptly
Stay updated on relevant occupational health standards and regulations
Case Management/Return to Work
Facilitate appropriate and timely case management with the focus on safe employee return-to-work and the return to maximum functionality
Provide communication, coordination and education required to optimize outcomes across the continuum of health, disability, workers’ compensation, and work-life issues
Provide initial contact with employee, employer, provider and other appropriate stakeholders (3 point contact) as soon as assignment is received
Maintain contact and communicate with the adjuster/TPA/employer assigned to the file through phone calls, email and written reports
Works as a liaison with the Client for return-to-work accommodation/limitations until fully released
Coordinates RTW exams as per client guidelines or DOT guidelines.
Coordinates Drug Testing exam as per client guidelines for RTW.
Coordinates Fit for Duty exams
Works with Client Medical Team for RTW if required or Medical Oversight at WorkCare if needed.
Understand limits of decision making authority delegated by the adjuster/TPA/employer to the nurse specialist and respects these limits
Keeps adjuster/TPA/employer up to date with activity in the case, case direction or secure authorization for services
Meets with Stakeholders to provide weekly updates on status of open cases
Monitor and oversee employee care including doctor’s visits, therapy sessions and return to work.
Contacts employees that are absent from work due to non-occupational injury or illness when appropriate, and monitoring Light Duty assignments
Works with and provides the employee’s physician with their job description for determination of return-to-work readiness, release date, and clearance to return-to-work.
Assists and interprets medical documentation to support medical accommodations/restrictions and consults with WorkCare Physician as needed
Follow up with employee’s PCP/Worker’s Comp Physician to clarification as needed
Obtain Release of Information to obtain medical records when required
Employ best practices that require early intervention and the setting of realistic expectations for disability duration, return-to-work, and return of functionality
Leave Management and Accommodations
Process all leave of absence requests which include but is not limited to, guiding employees through the leave process according to established policies, procedures and laws and collaborating with the Benefits Team.
Tracks leave time, provides timely and accurate responses to employee and all levels of management and collaborate with the Benefits Team.
Participates & facilitates in Return to work, Fitness for Duty Family Medical Leave requests, Transitional Duty, Reasonable Accommodations, and Ergonomic Risk Reduction Programs
Assists Occupational Health Service in scheduling required medical examinations, e.g., Fitness For Duty Examinations, Focused Examinations, Return to work Examinations, FMLA Second and Third Opinion Examinations, etc.
Assists and Interprets medical documentation to support Medical Accommodations or FMLA requests and consults WorkCare Physician when necessary for approval or denial.
Interprets guidelines which include OSHA rules and regulations; medical policy and procedures, Employer policy and procedures, DOT regulations, HIPAA guidelines, FMLA guidelines, and STD/LTD benefits.
Performs other additional duties and assumes additional responsibilities as identified by supervisor for the efficient operation of WorkCare.