Nurse Case Manager
for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. But we should only include sections that have real content. So we need About the role (summary), Responsibilities, Requirements (maybe combine Employment Qualifications?), Qualifications (maybe same as Requirements?), Skills, Pay. The instructions say use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can have both Requirements and Qualifications if content distinct. The posting has "Employment Qualifications" (license, BSN preferred, continuous learning, certification). Also "Experience" (three years active patient care, three years workers' comp case management preferred). That could go under Requirements or Qualifications. We'll decide: Requirements could be experience and licensure; Qualifications could be education and certification. But we can also combine. However we need to follow instruction: use those headings when we have content. We'll create sections: About the role (summary), Responsibilities, Requirements (experience), Qualifications (education/license/certification), Skills, Pay.
We must not repeat job title as heading. No Job ID.
We need to use - for any list of duties/requirements/benefits. For prose use
. So for responsibilities we need list items. For requirements list items. For qualifications list items. For skills list items. For Pay maybe just a
with range.
We must preserve all substantive information: need to include details like applying medical knowledge, reviewing workers' compensation claims, assessing, evaluating, planning, implementing, overseeing treatment appropriateness based on evidence based guidelines, utilizing clinical knowledge to evaluate medical and disability needs, facilitate coordination, timely return to work, engaging claimant and physician(s), proactive medical and disability management, collaborating with claim handlers, focusing on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to ensure optimal outcomes. Also responsibilities list: demonstrate and be accountable for standards of practice policies and procedures, quality assurance and goals of organization; manage treatment of claimants through workers' compensation system based on individual's diagnosis and state workers' compensation regulations; obtains and reviews patient clinical status and history to determine casual nature of patient's symptoms as related to reported work injuries; applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during interview process, documentation and intervention with claimant, their family or significant other; determines medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case; formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required; communicates final decision and subsequent ramifications to claim handlers; presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers' compensation, state, industry and division rating standards and policies, in conjunction with the claim handler. As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct.
We need to include that as part of responsibilities maybe.
Qualifications: Registered Nurse license active and unrestricted required. Bachelor’s degree in Nursing (BSN) preferred. Continuous learning required, as defined by the Company’s learning philosophy. Certification or progress toward certification is highly preferred and encouraged.
Experience: Three years active patient or clinical care experience as a Registered Nurse required. Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred.
Skills/Knowledge/Abilities: Required Knowledge of clinical care and jurisdictional requirements. Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction. Strong time management skills. Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required. Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making. Proficient with computer and Microsoft Windows Suite. Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.
Working Conditions: Work is performed in an office setting with no unusual hazards. Minimal travel. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. (We could include Working Conditions as a section? Not required headings list includes Benefits, Pay, Schedule. Working Conditions not in list, but we could still include as a section? The instruction says use those headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but says use those for those specific sections. It says "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It implies those are the allowed headings. Probably we should stick to those. Working Conditions could be omitted or placed under About the role? But it's substantive. However we could include it as a
under About the role or Responsibilities? Might be okay to include as a separate section not listed? The instruction says use those headings for section headings (e.g...). It doesn't explicitly forbid other headings, but to be safe we could incorporate Working Conditions into About the role or Responsibilities as a paragraph. However the instruction says "Prefer a few substantive sections over many thin ones." So we could omit Working Conditions as separate and just include its content in About the role or Responsibilities. But we need to preserve ALL substantive information. So we need to include that info somewhere. We could add a
under About the role after the summary, or under Responsibilities. Probably best to add a
under About the role after the summary describing working conditions.
Pay: we have Pay Range: between $63,000 and $90,400. Also note that actual compensation decision relies on internal equity etc. We should preserve that too. So Pay section includes that prose.
Now we need to strip boilerplate: "We are an Equal Opportunity Employer..." etc. Also "This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required." That's generic but maybe considered boilerplate? It's part of the description but maybe we should keep? It's not specific to role; it's generic. The instruction: "Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions." That line is not EEO but it's a generic statement about position description. Might be considered boilerplate? It's not EEO, but it's a standard disclaimer. I'd lean to remove it as it's not substantive specific to role. However the instruction says preserve ALL substantive information; that line is not substantive about the role. So we can remove.
Also "The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description." That's also generic; could be removed. But it's summarizing qualifications; maybe we can keep as part of Qualifications section? It's generic but still about qualifications. Might be okay to keep. However to be safe, we could keep it as a
under Qualifications.
Now we need to format.
Structure:
About the role
Summary paragraph: The Nurse Case Manager (NCM) is responsible for applying medical knowledge in reviewing workers’ compensation claims to assess, evaluate, plan, implement and oversee the treatment appropriateness for occupational injuries based upon evidence based guidelines. The NCM utilizes clinical knowledge to evaluate the medical and disability needs of an injured worker against relevant policies, facilitate coordination of the patient’s medical treatment and timely return to work. The NCM engages the claimant and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers in providing focused claim resolution and return to work driven outcomes. The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes.
Working Conditions: Work is performed in an office setting with no unusual hazards. Minimal travel.
Responsibilities
- Demonstrate and be accountable for the standards of practice policies and procedures, quality assurance and the goals of the organization.
- Manage treatment of claimants through the workers’ compensation system based on the individual’s diagnosis and state workers’ compensation regulations.
- Obtains and reviews patient clinical status and history to determine casual nature of patient’s symptoms as related to reported work injuries.
- Applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during the interview process, documentation and intervention with the claimant, their family or significant other.
- Determines the medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case.
- Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required.
- Communicates final decision and subsequent ramifications to claim handlers.
- Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers’ compensation, state, industry and division rating standards and policies, in conjunction with the claim handler.
- As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct.
Requirements
- Three years active patient or clinical care experience as a Registered Nurse required.
- Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred.
Qualifications
- Registered Nurse license active and unrestricted required.
- Bachelor’s degree in Nursing (BSN) preferred.
- Continuous learning required, as defined by the Company’s learning philosophy.
- Certification or progress toward certification is highly preferred and encouraged.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
Skills
- Required Knowledge of clinical care and jurisdictional requirements.
- Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
- Strong time management skills.
- Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required.
- Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making.
- Proficient with computer and Microsoft Windows Suite.
- Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.
Pay
Actual compensation decision relies on the consideration
. So for responsibilities we need list items. For requirements list items. For qualifications list items. For skills list items. For Pay maybe just a
with range. We must preserve all substantive information: need to include details like applying medical knowledge, reviewing workers' compensation claims, assessing, evaluating, planning, implementing, overseeing treatment appropriateness based on evidence based guidelines, utilizing clinical knowledge to evaluate medical and disability needs, facilitate coordination, timely return to work, engaging claimant and physician(s), proactive medical and disability management, collaborating with claim handlers, focusing on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to ensure optimal outcomes. Also responsibilities list: demonstrate and be accountable for standards of practice policies and procedures, quality assurance and goals of organization; manage treatment of claimants through workers' compensation system based on individual's diagnosis and state workers' compensation regulations; obtains and reviews patient clinical status and history to determine casual nature of patient's symptoms as related to reported work injuries; applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during interview process, documentation and intervention with claimant, their family or significant other; determines medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case; formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required; communicates final decision and subsequent ramifications to claim handlers; presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers' compensation, state, industry and division rating standards and policies, in conjunction with the claim handler. As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct. We need to include that as part of responsibilities maybe. Qualifications: Registered Nurse license active and unrestricted required. Bachelor’s degree in Nursing (BSN) preferred. Continuous learning required, as defined by the Company’s learning philosophy. Certification or progress toward certification is highly preferred and encouraged. Experience: Three years active patient or clinical care experience as a Registered Nurse required. Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred. Skills/Knowledge/Abilities: Required Knowledge of clinical care and jurisdictional requirements. Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction. Strong time management skills. Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required. Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making. Proficient with computer and Microsoft Windows Suite. Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner. Working Conditions: Work is performed in an office setting with no unusual hazards. Minimal travel. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. (We could include Working Conditions as a section? Not required headings list includes Benefits, Pay, Schedule. Working Conditions not in list, but we could still include as a section? The instruction says use those headings for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). It doesn't forbid other headings, but says use those for those specific sections. It says "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It implies those are the allowed headings. Probably we should stick to those. Working Conditions could be omitted or placed under About the role? But it's substantive. However we could include it as a
under About the role or Responsibilities? Might be okay to include as a separate section not listed? The instruction says use those headings for section headings (e.g...). It doesn't explicitly forbid other headings, but to be safe we could incorporate Working Conditions into About the role or Responsibilities as a paragraph. However the instruction says "Prefer a few substantive sections over many thin ones." So we could omit Working Conditions as separate and just include its content in About the role or Responsibilities. But we need to preserve ALL substantive information. So we need to include that info somewhere. We could add a
under About the role after the summary, or under Responsibilities. Probably best to add a
under About the role after the summary describing working conditions. Pay: we have Pay Range: between $63,000 and $90,400. Also note that actual compensation decision relies on internal equity etc. We should preserve that too. So Pay section includes that prose. Now we need to strip boilerplate: "We are an Equal Opportunity Employer..." etc. Also "This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required." That's generic but maybe considered boilerplate? It's part of the description but maybe we should keep? It's not specific to role; it's generic. The instruction: "Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions." That line is not EEO but it's a generic statement about position description. Might be considered boilerplate? It's not EEO, but it's a standard disclaimer. I'd lean to remove it as it's not substantive specific to role. However the instruction says preserve ALL substantive information; that line is not substantive about the role. So we can remove. Also "The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description." That's also generic; could be removed. But it's summarizing qualifications; maybe we can keep as part of Qualifications section? It's generic but still about qualifications. Might be okay to keep. However to be safe, we could keep it as a
under Qualifications. Now we need to format. Structure:
About the role
Summary paragraph: The Nurse Case Manager (NCM) is responsible for applying medical knowledge in reviewing workers’ compensation claims to assess, evaluate, plan, implement and oversee the treatment appropriateness for occupational injuries based upon evidence based guidelines. The NCM utilizes clinical knowledge to evaluate the medical and disability needs of an injured worker against relevant policies, facilitate coordination of the patient’s medical treatment and timely return to work. The NCM engages the claimant and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers in providing focused claim resolution and return to work driven outcomes. The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes.
Working Conditions: Work is performed in an office setting with no unusual hazards. Minimal travel.
Responsibilities
- Demonstrate and be accountable for the standards of practice policies and procedures, quality assurance and the goals of the organization.
- Manage treatment of claimants through the workers’ compensation system based on the individual’s diagnosis and state workers’ compensation regulations.
- Obtains and reviews patient clinical status and history to determine casual nature of patient’s symptoms as related to reported work injuries.
- Applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during the interview process, documentation and intervention with the claimant, their family or significant other.
- Determines the medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case.
- Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required.
- Communicates final decision and subsequent ramifications to claim handlers.
- Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers’ compensation, state, industry and division rating standards and policies, in conjunction with the claim handler.
- As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct.
Requirements
- Three years active patient or clinical care experience as a Registered Nurse required.
- Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred.
Qualifications
- Registered Nurse license active and unrestricted required.
- Bachelor’s degree in Nursing (BSN) preferred.
- Continuous learning required, as defined by the Company’s learning philosophy.
- Certification or progress toward certification is highly preferred and encouraged.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
Skills
- Required Knowledge of clinical care and jurisdictional requirements.
- Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
- Strong time management skills.
- Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required.
- Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making.
- Proficient with computer and Microsoft Windows Suite.
- Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.
Pay
Actual compensation decision relies on the consideration