Provider Relations and Outcomes Manager - RN

Synergy Comp is a monoline Workers' ​Compensation carrier founded in 2006.   that specializes in providing highly effective workers’ compensation and workplace safety solutions that seamlessly combine innovative claims resolution, risk management, and loss prevention strategies with a total commitment to creating a culture within the workplace that embraces safety as a core operating principle. 

Our goal is to form long term relationships with companies that are looking to drive down their claims and safety costs, improve employee morale and ultimately add dollars to their bottom line. 

Who You Are:

The Provider Relations & Outcomes Manager - RN manages panel onboarding, relationship, and results. The Provider Relations & Outcomes Manager’s primary focus is on the partnership of the panel medical providers with a focus on speed to care, prompt injury recovery, and transitional return to work. The Provider Relations & Outcomes Manager provides comprehensive quality telephonic case management to proactively drive a medically appropriate return to work and medical progression through engagement with the injured employee, provider, and employer. The Provider Relations & Outcomes Manager is empathetic, informative, and collaborative. This position coordinates medical resources for our injured employees and partners with our Claims team to develop a personalized holistic approach for each claim.

What You’ll Do:

· Support safety professionals employee work-related illness and injury trends and assesses, develops, and implements strategies to prevent work-acquired injury or illness and expedite return to work.

· Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered upon request for review by the handling claims manager.

· Ensure injured employees receive appropriate level and intensity of care through the use of medical and disability duration guidelines directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.

· Communicates effectively with the claims department, client, vendor, supervisor, and other parties as needed to coordinate appropriate medical care and return to work.

· Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client’s situation to include psychosocial needs, cultural implications, and support systems in place on an as-needed basis.

· Oversee the results of medical providers to include PBM, DME, and managed care to ensure meeting outlined company expectations.

· Oversee and drive desired results with panel physicians. Assess current and future needs in managing company expectations with speed to care, claim resolution, transitional return to work, and communications with the team.

· Develops medical resolution strategies to achieve maximal medical improvement or the appropriate outcome.

· Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim when appropriate.

· Provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.

· Manage panel and provider onboarding and management, including but not limited to reviewing and finalizing new panels and panel changes.

· Conduct telephonic case management on an as-needed basis pending jurisdictional requirements and/or case specifics.

What You’ll Need:

• Bachelor’s degree in Nursing
• 3+ years of relevant nursing experience
• Registered Nurse
• Knowledge of current literature applicable to occupational health and/or worker’s compensations.
• Ability to make knowledgeable clinical assessments and judgments
• Ability to provide counseling and emotional support with compassion and respect for the individual.
• 25% travel required

• Comprehensive benefits package, including health and wellness benefits
• 401K with company match
• Generous annual performance bonus
• Flexible work environment
• Great company culture which has earned us several awards including, Best Places to Work and Fastest Growing Companies 
• Profit-Sharing

Please check out our website for more information:

https://www.synergyinsurance.com/working-for-synergy    

Equal Employment Opportunity