Std Case Manager Jobs in Riverside, CA (NOW HIRING)

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.   

Job Requirements: 

Education and Experience  

• Associate’s degree or equivalent, Bachelor’s degree preferred 

• Active RN or LPN license required 

• Minimum 2 years nursing experience RN or LPN required 

• Experience in occupational health nursing preferred 

• Certification in Occupational Health is a plus 

Skills and Competencies  

• Strong verbal, written and interpersonal communication skills.  

• Must be able to demonstrate the ability of maintaining privacy and confidentiality.   

• Strong critical thinking skills; problem solving, and decision making.   

• Must have the ability to gather data, compile information and prepare reports.   

• Ability to manage multiple priorities, with attention to detail and accuracy.   

• Ability to create and edit written materials.   

• Ability to communicate effectively to a variety of audiences.   

• Skill in organizing resources and establishing priorities.   

• Demonstrate cooperative behavior with colleagues, supervisors and clients.  

• Strong time management, organizational, and follow-through skills.  

• Ability to meet and exceed daily and weekly individual performance goals.  

• Ability to work independently as well as assisting other team members when needed.  

• Requires regular and predictable attendance and punctuality.   

Computer Skills  

• Must be competent in the Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed. 

Physical Demands  

• Requires sitting for long periods of time, working at a desk.  

• Some bending and stretching could be required.  

• Working under stress and use of computer/phone required.  

• Manual dexterity required for use of computer keyboard.  

• Occasionally may be required to stand, walk, stoop, kneel and/or crouch.  

• May occasionally lift and/or move up to 15 pounds.  

Work Environment  

• Work Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. At home set up must meet all Company IT, privacy and safety requirements. 

This position has an hourly pay range of $35.00 - $45.00 per hour. Final compensation rate for this position depends on factors such as job-related knowledge, skills, experience, and qualifications. 

Benefits for this position include paid time off; medical, dental, vision, and critical illness insurance; HSA, HRA, and FSA; life and disability insurance; EAP; 401K; legal and identity theft coverage; pet insurance and more. 

The preceding statements describe the general job responsibilities and individual’s qualifications inherent to this position. These are not intended to be construed as exhaustive lists. To perform this job successfully, the individual must be able to perform each essential function satisfactorily, accurately, and safely. Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions of their jobs. This job description may be reevaluated and/or modified at any time without notice.  

Every qualified individual has the same opportunity for recruitment, hire, training, transfer, promotion, compensation, benefits, employee activities, and general treatment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other classification protected by applicable local, state, or federal law.