POSITION GOAL
The Workers’ Compensation Nurse Case Manager is responsible for first‑line telephonic medical case management related to individual claims. The role determines and executes all medical consumerism activities on individual claims, with the principal goal of assuring accurate issue/problem identification, facilitating appropriate clinical/medical resolution (return to health), and optimal functional restoration, including Stay‑at‑Work/Return‑to‑Work (SAW/RTW).
ESSENTIAL PERFORMANCE RESPONSIBILITIES
Serve as custodian of the district’s workers’ compensation program core principles.
Build a strong partnership with paired adjuster to support and integrate medical services into the overall claim strategy.
Develop individual medical action plans to bring claims to appropriate closure.
Identify specific claim issues during daily medical management activities, determine appropriate solutions, and reach collaborative resolution.
Manage assigned inventory of claims to closure through proactive medical consumerism activities including authorizations, referrals and reimbursement.
Serve as a conduit of medical information, documenting and communicating relevant activity within the claims administration system and among claim parties.
Make determinations regarding initial and ongoing investigation of medical causality.
Assess the health and functional status of employees through collection of medical and disability data.
Evaluate medical record history to provide guidance and advice regarding all aspects of claim decisions, including denial.
Utilize appropriate claim diary management practices/actions (scheduling of future medical case management activities).
Identify and elevate claims meeting pre‑determined criteria to the medical supervisor.
Participate in multi‑disciplinary team meetings for round‑table group evaluation, planning and implementation of case strategy.
Review claim‑level data and reports to manage day‑to‑day medical activities.
Prepare medical abstract reports for incorporation into round‑table reviews and reporting to the district’s excess carrier, defense counsel, and other claim parties.
Serve as patient advocate and principal contact during claim, coordinating and explaining medical care concerns, issues and activities, including SAW/RTW facilitation.
Utilize merit‑based decision‑making at all times, integrating case facts, science, evidence‑based medicine, and statutory parameters.
Provide objective feedback regarding cooperation, performance and other relevant parameters concerning clinicians, site administrators, representatives, and other system participants to support macro program management activities.
MINIMUM QUALIFICATIONS & EXPERIENCE
Licensed Registered Nurse from an accredited program, or nursing certification from an accredited institution.
Minimum 2 years of clinical nursing experience and/or 1 year of telephonic handling of all aspects of workers’ compensation medical case management (facilitation, coordination, medical consumerism, SAW/RTW coordination, causality determination).
Active Florida RN license in good standing.
Medical case management certification (e.g., CCM or CCRN) or agreement to obtain within 1 year.
Computer skills required for the position.
PREFERRED QUALIFICATIONS & EXPERIENCE
Bilingual skills.
SIGNIFICANT CONTACTS – FREQUENCY, CONTACT, PURPOSE
May occasionally interact with contracted service providers to ensure the district’s program aligns with strategic direction, policies and procedures. Regular communication with claim stakeholders—including injured workers, site administrators, physicians, other clinicians, defense counsel, regulators—will discuss individual claim tactics for issue or claim resolution.
PHYSICAL REQUIREMENTS
Light work: Exert up to 20 pounds of force occasionally, and up to 10 pounds of force frequently as needed to move objects.
TERMS OF EMPLOYMENT
Salary and benefits shall be paid consistent with the district’s approved compensation plan. Length of the work year and hours of employment shall be those established by the school board.
LINK TO FULL JOB DESCRIPTION
https://www.browardschools.com/Page/36072 (search by Job Code CC-067)
NOTE
Two positions; one for each requisition. Candidates must apply to both requisitions to be considered for both positions.