Lowe's Lowe's Care Nurse in Charlotte, North Carolina
The Lowe’s Care Nurse is an office-based telephonic medical case management position with emphasis on early intervention, with an advocate approach that emphasizes return to work, coordination of quality medical care on claims involving disability and medical treatment, assessment and intervention, including psychosocial factors, for catastrophic and complex cases on workers’ compensation injuries. This position is responsible for ensuring that employees receive appropriate treatment and/or assist claim examiners in managing medical treatment to an appropriate resolution.
The candidate will be working directly for a Fortune 100 company with a high volume of claims per year for its US operations. The Care Manager will be responsible for medically managing a minimum caseload of 65.
The Lowe’s Care Nurse must have the following knowledge:
•Strong clinical background, preferably within the orthopedic/neurological/occupational specialties
•Strong knowledge of medical management regulations in multiple jurisdictions
•Working knowledge of Workers Compensation laws and regulations
•Knowledge of state and national treatment protocols and physician advisor/peer review programs
•Ability to communicate with medical providers, employees and Human Recourse on claims involving medical treatment and /or disability to coordinate appropriate medical care.
•Analyzes workers’ compensation cases and recommend actions to facilitate resolution
•Develop case strategy and facilitate a return to work plan using established protocols
•Ensure that medical providers have a treatment plan that returns the employee to their best state and analyze the plan to identify gaps and barriers to recovery.
•Work with medical providers and encourage cost effective treatment alternatives, where appropriate.
•Utilizing of Occupational Disability Guidelines and State Treatment guidelines to determine criteria for medically necessary treatment
•Understand the pharmacological factors and its impact upon work injuries
•Obtain medical records from providers telephonically during initial contact, and follow up with written correspondence if necessary.
•Discuss medical information and disability status with claims examiner and integrate into overall strategy to ensure appropriateness of indemnity payments.
•Provide technical assistance and act as a resource for claims staff.
•Attend and participate in file reviews and roundtables on assigned cases.
•Identify cases requiring task assignments to field case managers
•Maintain confidentiality of medical information and personal health information
•Direct to appropriate network providers and provide feedback regarding provider nominations and experience with providers.
•Comply with established Best Practices, Corporate policies and procedures
•Support the company’s standard for customer service by a positive and professional attitude
•Have the ability to meet licensing requirements in all 50 states, if requested by the employer.
•Perform other duties as required
The Care Nurse must possess the following technical skills:
•Intermediate level for Microsoft Outlook is required
•Beginner level or stronger skill level with Microsoft Excel and Word
•Demonstrate excellent written and verbal communication skills
•Capable of using an online care management software application/program
Essential and Core Responsibilities:
•Manage an assigned caseload of medical workers’ compensation cases
•Empower the employee with the tools and education to make informed decisions on their treatment options and set recovery expectations
•Responsible for evaluating factors requiring judgment and problem-solving; promote return to work
•Work productively and in cooperation with internal and external personnel on a consistent basis
•Educate claims examiners and human resource staff on medical conditions and concerns
•Teamwork for claims resolution
•Ability to apply for professional licenses in assigned states as required
•Pursues self-development and effective relationships with others by organizing resources and information; seeking performance feedback; adapting to and learning from change, difficulties, and feedback
•Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; displays high level of effort and commitment towards performing work and demonstrates responsible behavior
Functional Competencies Needed:
•Ability to work independently
•Demonstrated time management and priority setting skills
•Demonstrated interpersonal/verbal communication skills
•Ability to develop, review and interpret treatment plans
•Demonstrated negotiation skills
•Ability to effectively present information and respond to questions from employees, medical providers and claims examiners
Required Minimum Qualifications:
•Bachelor’s Degree in Nursing and 3 year of clinical experience or Associate’s Degree with 5 years of experience in a clinical position.
•5+ years of experience as a Case Manager or Utilization Review Nurse in worker’s compensation
•Strong communications skills along with the ability to work well cross- functionally within the company, medical providers and third party vendors
•3 years of experience required with Nurse Case Management Software, along with Microsoft Office
•Unrestricted RN license in home State
•CCM, CRRN, CDMS, COHN or certification eligible
•Must have the ability and flexibility to work in an environment of change
Occasional travel will be required.
• This position will reside in an office setting
•Demonstrated experience in crisis management, coaching, educating and negotiating
Lowe's Companies, Inc. (NYSE: LOW) is a FORTUNE® 50 home improvement company serving more than 18 million customers a week in the United States, Canada and Mexico. With fiscal year 2017 sales of $68.6 billion, Lowe's and its related businesses operate or service more than 2,390 home improvement and hardware stores and employ over 310,000 people. Founded in 1946 and based in Mooresville, N.C., Lowe's supports the communities it serves through programs that focus on K-12 public education and community improvement projects. For more information, visit Lowes.com.
Job ID: 1383808BR
Line of Business: Corporate
Job Category: Risk Management
Department: 0282 - Risk Management
Employment Type I: Regular
Employment Type II: Full-Time
Location #: 3332
Location Name: Sedgwick CMS - Charlotte, NC
Lowe’s is an equal opportunity employer and administers all personnel practices without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity or expression, marital status, veteran status, genetics or any other category protected under applicable law.