The candidate will work with Injured Workers (IW) and their providers, all DH staff and insurance company (adjusters and RN Case Managers) to facilitate timely access to needed care for post-injury recovery, continued coverage of recommended treatment and facilitation of return to work.
Intervening with patients at any point of entry to the DH system at DH to answer questions about the Work Comp (WC) system and the patient’s rights and responsibilities. Review patient’s understanding of injury and plan of care, encourage communication between IW, WC carrier, and the employer regarding injured worker recovery and timely return to work, and assist in navigating systems internal and external to DH.
The candidate will work with all Departments in community group Practices to provide information and support to staff and providers in the management of the IW and in navigating the Worker’s Compensation System. Provide "at the elbow support" to providers with WC medical form, provide assistance with management of the WC claim, and provide guidance to support staff in managing the medical/legal aspects of a WC claim. Assist with accessing critical insurance information and ensure Insurance acceptance of injured worker’s claim includes understanding of the pre-auth process. Provide expedited access to medical records.
Works to assess and improve systems of care that support the care and treatment of Injured Workers through quality improvement processes i.e. Reception staff, and call center to answer questions and to improve communication and management of IW’s.
Manages and coordinates clinical care of defined populations with identified preventive care and/or chronic disease needs in the outpatient setting.
Serves as the point of contact for patients and families at risk. Facilitates access to care.
Develops strategies with health care team to advocate for patient needs. Works with CCM to negotiate complex systems to remove barriers and limitations in accessing health care. Identifies needs for a home environment and safety evaluation.
Facilitates educational opportunities and risk avoidance, performs pre-provider visit planning to ensure productive, effective patient-provider interactions, and performs post-provider visit wrap-up and between visit contact to ensure patient understanding of the treatment plan, develops patient driven goals and strategies to maximize patient ability to meet health specific goals.
Participates in the development of work injury management strategies and identifies appropriate measures for the evaluation of outcomes. Determines potential focus for groups of patients using available data and tools.
Contributes to the development and maintenance of a care delivery system which is patient/family centered, and promotes effective resource utilization.
Collects and evaluates clinical and financial data/outcomes including patient satisfaction, health and functional status, resource utilization and role effectiveness. Identifies and recommends opportunities for improvement across the system. Leads and participates in quality improvement projects for the practice, especially related to the management of patients with work injuries. Participates in case conferencing in conjunction with peers and the clinical team. Assists in the development of department annual goals and the identification of outcomes for continuous quality improvement.
Performs other duties as required or assigned.
Bachelor’s degree with 3 years of experience in a community-based practice or health plan or the equivalent required.
Excellent assessment, communication, interpersonal, and organizational/time management skills.
Demonstrated ability to work well as a member of a team and respond calmly and effectively in a fast paced environment.
Excellent verbal and written communication skills.
Sound decision making, judgment, time management and negotiating skills.
Strong knowledge of computer applications including MS Word, Excel and Power Point.
Familiarity with electronic medical records, and computer applications including MS Word and Excel.
Must demonstrate passion for care of patients with chronic disease.
Sound decision making, judgment, and negotiating skills.
Knowledge of methods to educate and counsel patients, assess their readiness for changing health behaviors.
Required Licensure/Certification Skills:
Current certification in BLS
RN or Social Worker license in the state of NH