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The Nurse Consultant reviews the medical aspect of claims from multiple lines of business such as Business Insurance, Personal Lines, etc. and prepares chronological reports at the request of the claims handler that include case analyses and insight related to bodily injury, treatment received by claimant, and future medical treatments. In addition to composing formal written analyses, also conducts files reviews and generates medical opinions on an informal basis. The format of the review is dependent on the nature and extent of the medical analysis needed, the medical explanation required to answer the claims handler or defense attorney's questions, as well as the needs of each line of business. In addition to performing research and consultation on medical issues and providing ongoing education and training to the Claims staff on medical aspects frequently seen in the claims, also analyzes medical trends based on geographic regions or injury type and identifies relevant medical issues for education and awareness in order to improve the quality outcome of files. Also provides litigation support to the Adjuster in order to further assist the claims team and defense attorney in providing education and/or clarification relating to questions which may arise around the alleged injury and/or treatment. This is done by attending mediations and depositions, preparing questions for plaintiffs and independent medical examinations, reviewing and analyzing expert witness reports/deposition testimony, and providing medically appropriate suggestions.
***Location for this role can be Westlake Village, CA or Phoenix, AZ or Austin, TX.***
Essential Job Functions
Receives requests for medical review from the Claims Adjuster and partners with Farmers Claims handler and/or Legal representative to determine file review needs. This includes addressing medical questions, assessing time sensitive deadline demands by which the r equestor may need medical reports, reviewing as well as analyzing medical records and other relevant documents (e.g. deposition transcripts, accident reports, photographs etc.) and conducts necessary research in order to properly assess injuries alleged for each claimant involved. In addition, also completes the review of Claims as it relates to alleged injury, treatment of alleged injury and future treatment to provide claims handler and/or defense attorney with medical analysis/medical explanation of injury. Provides litigation support to Claims team and defense attorney by reviewing medical records and other relevant documents of claim files to provide medically appropriate suggestions for depositions, mediation proceedings, and round table meetings. This includes analyzing transcripts, medical and accident reports, photographs and other related file items to provide an accurate and efficient medical evaluation of the claim. May also be required to attend depositions, mediations and round table meetings to provide medically appropriate suggestions to the claims team or defense attorney. Develops as well as delivers training and education via one-on-one, online, or in classroom settings to Claims professionals on various medical topics commonly seen in Claims, including but not limited to, traumatic brain injury, spinal injections, soft tissue damage, and spinal, knee, and shoulder injuries. Keeps up-to-date on latest medical research and trends by reviewing relevant and upâto-date medical literature via various means (e.g. attending conferences, participating in online courses, etc.) and through accessing the Farmers medical library via the SharePoint site. Maintains certifications for advanced degrees and applicable licensure (e.g. RN, JD, LNCC), participates in special projects as needed, and performs other duties as assigned.
Primarily a sedentary job that may require travel up to 25% of the time and carrying up to 25 lbs.
Required job duties are normally performed in a climate-controlled office environment, but with exposure to some or all of the following environments when in the field: â¢ Uncontrolled outside environmental conditions â¢ Excessive noise levels â¢ Chemicals/biological conditions â¢ Moving mechanical parts â¢ Areas considered dangerous which could affect the respiratory system or skin, such as fumes, odors, dust mists, gases, oils, smoke, soot, or poor ventilation.
Nursing degree and a current unrestricted Registered Nurse license required with Bachelor of Science in Nursing preferred
Two years as a legal nurse consultant or comparable experience such as paralegal, attorney or risk manager required Training experience in preparing and presenting medically related subject matter on topics such as traumatic brain injury, spine, and injections to claims handlers and attorneys preferred.
***The ideal candidate will have at least 5 years of workers compensation experience with other carriers. Specifically looking for medical management experience in utilization review, nurse case management (telephonic or field) and certified care networks.***
Special Skill Requirement
Strong communication, writing, interpersonal and teaching skills required.
Farmers is an equal opportunity employer, committed to the strength of a diverse workforce.
Job Posting: 06/20/2018