Serve as an expert resource specializing in Worker's Compensation files, focusing on pharmaceutical intervention. Utilize clinical guidelines to ensure appropriate treatment patterns, preventing long-term medication dependency in complex cases. Manage files actively to intervene as needed for optimal claim outcomes, providing training to enhance Pharmacy management across teams.
Key Responsibilities
Assess medical treatment requests against established guidelines.
Collaborate with Claims Adjusters to evaluate file status and treatment impacts.
Provide ongoing training and support to enhance Pharmacy management within the Claims and Managed Care Department.
Educate on and leverage Pharmacy tools to maximize program utilization and achieve optimal outcomes.
Establish timelines with providers to ensure medication treatments align with guidelines.
Respond to alerts to intervene when medication regimes exceed recommended doses or durations.
Facilitate Drug Utilization Reviews to explore alternative therapies.
Coordinate Peer-to-Peer consultations between medical specialists.
Recommend appropriate exam objectives for Independent Medical Exams.
Apply state Medical Treatment Guidelines for optimal medication management.
Recommend Utilization Review processes as needed.
Coordinate weaning protocols with Pain Management and treating providers.
Facilitate face-to-face provider collaborations when needed.
Support narcotic contracts to manage long-term medication dependency risks.
Uphold Company's Code of Business Conduct and Ethics, ensuring compliance with applicable standards and laws.
Requirements
Bachelor of Science in Nursing, Healthcare, or Occupational Medicine.
Active Registered Nurse (RN) license(s); additional state-specific licenses may be required.
Minimum three years of clinical experience in orthopedics, neurology, critical care, emergency trauma, general surgery, rehabilitation, physical medicine, or occupational health.
Familiarity with regulatory requirements related to Worker's Compensation medical management.
Proficiency in MS Office Suite, email communications, proprietary systems, and internet research.
Application
If you are passionate about optimizing pharmaceutical interventions in Worker's Compensation cases and possess the required qualifications, we invite you to apply. Join our team dedicated to achieving positive outcomes and enhancing patient care in occupational health.
Employment Type: Full-Time
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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