Contra Costa County Schools Insurance Group (CCCSIG)

The Contra Costa County Schools Insurance Group (CCCSIG) is a Joint Powers Authority organized in 1977 for the purposes of self-insuring workers’ compensation and provision of health & safety services to its member public school districts in Contra Costa County. Today, CCCSIG operates a self-insured, self-administered public agency, which is one of the largest of its kind in the State of California. Of the 21 member districts, 19 are K-12 school districts, one County Office of Education and one Community College District. CCCSIG’s workers’ compensation program encompasses approximately 20,000 employ-ees and more than $819 million in payroll, which translates to approximately $21 million in workers’ compensation premium. Of the 21 member districts, 19 are active in the workers’ compensation program and 7 are members of an insured Health Benefits Program. CCCSIG has been recognized for success in leader-ship by its peers. First accredited by the California Association of Joint Powers Authorities (CAJPA) in 1993, the Group is currently Accredited with Excellence. CCCSIG is committed to customer service and cost containment for its member districts. Some of the programs implemented by CCCSIG, that have assisted with decreasing the cost and number of workers’ compensation claims are a strong early return-to-work program; in-house bill review; an in-house nurse; post offer, pre-employment strength testing; wellness and safety services, which include ergonomic evaluations, trainings and presentations in all areas of wellness and safety; as well as many other resources made available to members. CCCSIG’s commitment to customer service has been evident throughout the numerous independent, as well as State and internal controls audits that have been completed throughout the years, which have all come back with outstanding results. CCCSIG was recognized by the State of California with a “Fit Business Award”. CCCSIG was recognized in the small business category, for being on the forefront of providing employees a worksite environment that supports healthy choices, as well as recognizing the many programs and procedures that CCCSIG has in place for overall employee wellness. CCCSIG’s overall attitude towards employee health, wellness and safety carries over to its member districts, through the health, safety, and claims services provided and our commitment to enhance the human and financial resources of its members in order to contribute to public education.

Job Title: Nurse Case Manager - Must have Workers' Comp and Utilization Review Experience

Job Description 

Class specifications are intended to present a descriptive list of the range of duties performed by employees in the class. Specifications are not intended to reflect all duties performed within the job.

Manages, coordinates and supervises the on-site case management of catastrophic, as well as general, worker’s compensation cases and provides the necessary medical services for clients to facilitate their successful return to medical stability and, when possible, to regular employment. Duties include coordination of cost effective, quality medical case management implemented through client assessment, consulting with physicians as needed regarding treatment plans, evaluation of medical treatment and services to include input on potential medical costs, and research of alternative treatment plans when appropriate. Facilitates optimal client (injured worker) recovery by functioning as the liaison between CCCSIG, the local District, and the medical community. Provides clear written reports for client evaluations and medical treatment plans for review by CCCSIG’s Claims Manager and/or the Executive Director. Provides assistance to the Health & Safety Services Department in the planning and presentation of appropriate Wellness Programs for CCCSIG and member Districts.

Directly responsible to the Claims Manager and/or Claims Supervisor as designated. May provide functional and technical supervision to the Early Return-To-Work Specialist in coordinating return-to-work tasks, and the Claims Assistant in coordinating Utilization Review tasks.

The following tasks are typical for positions in this classification. Any single position may not perform all of these tasks and/or may perform similar related tasks not listed here:

• Review, analyze and document all referred material to ensure basic file knowledge.
• Contact client (injured worker), client’s attorney (when applicable), the District Claims Coordinator, and the treating physician to inform of CCCSIG’s involvement in the case and establish rapport.
• Perform initial medical evaluation and assessment through client interview and consult with treating physician to obtain current medical status and prognosis.
• Research and collect all pertinent medical information on client status; consult with employer for purpose of job analysis.
• Determine client’s assets and liabilities as pertaining to vocational rehabilitation process.
• Prepare written reports summarizing case findings with a statement of medical involvement potential and recommendations.
• May assist employees and districts with modified duty placements to include on-site review of working conditions and demonstration of modifications necessary for placement.
• May assist in OUR System coordination and placement when intervention is necessary for prompt placement.

• Arrange admission and discharge to/from hospitals or special treatment facilities as required.
• Coordinate outpatient arrangements for therapy as needed.
• Review medication consumption to determine proper intake and response to medications prescribed.
• Schedule Medical Evaluations by appropriate specialists as required.
• Coordinate necessary home services, i.e., modifications, home health attendants, equipment and supplies.
• Make appropriate recommendations regarding vocational consultation when required.
• Collaborate with CCCSIG staff members in the delivery of services as client transitions from one staff member to another during the course of care.
• May coordinate with vocational consultant, as appropriate, the client’s return to modified or regular work.
• May coordinate effective use of PPO discounts and fee schedule reductions whether provided for in-house with staff or by contract with outside providers.
• May conduct on-site workstation evaluations for the purpose of improving ergonomic work factors.
• Record and evaluate medical care provisions provided to the client and modify as case dictates to insure movement.
• Submit and modify, as appropriate, creative and innovative recommendations to accomplish the goals of medical rehabilitation.
• Maintain contact with all treatment facilities involved in the case to remain knowledgeable of services available to the client.
• Maintain effective working relationships with physicians and other treatment specialists.
• May obtain and evaluate disability findings, when appropriate.
• Evaluate home environment of the injured worker to immediately ascertain any possible barriers to rehabilitation process.
• Confer with previous employer to evaluate work environment to determine possibility of return to former job.
• Recommend and monitor job site modifications, when approved, to accommodate disability when required.
• Notify referral source of cases not feasible for rehabilitation process.
• Develop medical plan compatible with client’s injury and progress to date.
• Make appropriate recommendations to achieve case progress and movement toward early case closure.
• Monitor plan and services; modify as case dictates to ensure movement.
• Submit creative and innovative recommendations which will accomplish the goal of achieving medical stability.
• Promptly and objectively prepare written Initial Medical Evaluation Reports.
• Keep referral sources routinely informed of case progress through monthly Status Reports.

• Write objective reports based on medical analysis and expertise with action-based recommendations.
• Inform all appropriate parties of report delays when encountered and document such delays in case progress notes.
• Ensure prompt response to all case inquires.
• Maintain current progress notes and up-to-date correspondence including notes.
• Complete all required case forms, i.e., File Logs, Internal File Review, and General Information Forms.
• Adhere to all CCCSIG Service Commitments, Standards, and time frames.
• Develop contacts with community rehabilitation facilities and organizations and maintain files of same.
• Make contacts with referral sources, i.e., Claims Examiners and/or District Claims Coordinators, as requested by the Claims Manager and/or Executive Director.
• Comply with standards of rehabilitation nursing practice as published by the American Nurses Association and the Association of Rehabilitation Nurses.
• Performs related duties and responsibilities as required and/or assigned.

Job Requirements 

Knowledge of:
• Medical peer review process, length of stay criteria and specialized service delivery.
• Psychology and physical aspects of a disability, principles of insurance, workers’ compensation law, rehabilitation process and managed care.
• Working with wide range of community resources and medical facility resources, long term care resources and labor market information resources.
• Self-help services, low back problems, home health services, home and job modification, adaptive devices and equipment.
• Effective counseling and case management techniques.
Ability to:
• Organize & analyze information & data.
• Establish and set work priorities.
• Understand oral and written instruction.
• Plan and present Employee Wellness training workshops.
• Communicate clearly, concisely, and effectively both orally and in writing.
• Work independently in the absence of supervision.
• Establish and maintain cooperative working techniques with those contacted in the course of work.

Apply by: Wed, 02/01/2023

To Apply, Contact:
(866) 922-2744