• Reviews claim data and identifies trends, root causes, or other areas of opportunity to decrease injuries, reduce costs, and improve program administration.
• Composes reports and correspondence to ensure communication between employees, UCMC defense attorneys, managers, HR, and WC TPA.
• Runs monthly reports for department work injury data.
• Coordinates the transitional duty program in collaboration with department managers.
• Reviews occupational injury/illness and workers compensation-related information and reports this to the appropriate staff and regulatory agencies (OSHA 300 log and IL WC Commission).
• Oversees establishment of workers’ compensation claims with third party administrator (TPA).
• Is primary contact for WC TPA.
• Provides expert case management for injured workers: consults with HCP to discuss treatment plans, strategies and RTW status; authorizes treatment for providers within and outside UCM, determines need for IMEs, UR, surveillance and vocational rehab; assigns litigated claims to attorneys.
• Reviews and ensures accurate and prompt payment of TTD by TPA.
• Responsible for updating, monitoring, and communicating any service level agreements issues or changes with the WC TPA, outside counsel or other vendors that provide WC services for UCMC employees.
• Approves weekly GB Funding requests for payment of GB services.
• Participates in leadership development programs, committee and subcommittee work: Safe Patient Handling, Institutional Safety, and Occ Med Safety Sub-committee.
• Refers employees to Sedgwick for STD or Leave Administration when a WC claim is denied.
• Audits medical charges from UCOM, Pharmacy, Radiology, and other internal hospital charges for appropriate billing; acts on incorrect charges in relation to Workers’ Compensation Program.
• Coordinates quarterly claim reviews with WC TPA and outside counsel.
• Grants settlement authority per UCMC finance policy.

• Bachelor’s degree (in nursing, Allied Health or related field preferred)
• Minimum of 3 years of prior experience in Workers Compensation Administration or a similar role
• Current knowledge of laws and regulations governing worker and worksite health and safety (i.e. OSHA, Illinois workers' compensation Act, ADA, FMLA).
• Knowledge of computer software and databases (e.g. Kronos, Oracle, EMRs)
• Knowledge of IL WC laws and regulations
• Ability to analyze complex medical information
• Good written and verbal communications skills and ability to work with diverse stakeholders including employers, doctors, TPAs, attorneys and claimants

• Register Nurse Licensed
• Certified Case Manager, certified WC specialist/professional,
• Certified Occupational Health Nurse (COHN)
• Advanced degree

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Day
• Unit/Department: Occupational Health – Hyde Park
• CBA Code: Non-Union

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