dcsimg

Career Story: Director Of Medical Services For A Workmen's Comp Provider

Director Of Medical Services For A Workmen's Comp Provider

Job Title: Director Of Medical Services

Type of Company: I'm employed by a Workers' Compensation provider that offers coverage to municipalities throughout New York state.

Education: AS, Applied Science (Registered Nurse), Junior College of Albany-Sage •• certified Case Manager •• certified Legal Nurse Consultant

Previous Experience: I was a critical care nurse for five years after college, then worked an an occupational health nurse for another three. I then became a case manager and worked my way up through the management hierarchy at an insurance company.

Job Tasks: My primary responsibility is to manage nurse case managers and oversee all other medical services for a workers' compensation provider. Outside services include pharmacy benefits, durable medical equipment, diagnostic imaging, independent medical exams, and additional ancillary services. Oversight includes monitoring delivery of services for quality and assuring service standards are met and delivered within professional and legislative standards. I am also responsible for developing and implementing wellness programs for all clients and educating them on the benefits of wellness initiatives in the workplace.

A typical day would include monitoring staff caseloads, reviewing case management files and providing feedback to staff and being a medical and technical resource for nurses and the claims adjusters. This often involves file reviews, researching and identifying standards of care for care planning and accurate claim reserves.

Another portion of the day is spent monitoring outside services for efficacy, quality, and service standards. This is captured by developing and evaluating reports or researching and answering staff and client complaints. I select the best vendor and eliminate those who don't meet our needs through requests for proposals (RFP) and continuous monitoring.

I am responsible for establishing and maintaining a budget for my department. I am involved in software needs for case management and claims, product development, fostering relationships with other company departments and outside clients, event planning, professional development, training and education. All of these components require that I stay abreast on a variety of topics. I am constantly looking forward, assessing company needs to ensure we remain competitive in a tough market. I often find myself in meetings in and outside the office and on the phone with other professionals working to accomplish these above tasks.

Best and Worst Parts of the Job: The best part of my job is problem-solving. I like to evaluate a problem or product and enjoy examining it for quality or a solution. I like the diversity of my responsibilities and the people I work with and the occasional travel opportunities.

The worst part is sometimes the quality of the people I work with. I have high expectations and they are not always met.

Job Tips:
1. I would recommend that a new graduate nurse get experience in critical care. Potential employers (in insurance, occupational health and case management) will hold that experience in high esteem and give you an opportunity to branch out if you choose to so so.

2. I suggest seeking certifications in your area of nursing (Critical Care, Case Management, etc.)

3. Work on professional development, such as organizational skills, communications, supervision, public speaking, anything to better yourself.

4. Seek the highest level of education possible.

Additional Thoughts: I would recommend that you challenge yourself professionally, seek higher education, expose yourself to different work environments to gain new knowledge, take opportunities to network, learn from others, and don't doubt your abilities.

If I were to do anything differently, I'd get more schooling.

The most important personal qualities for my job are multi-tasking, management skills and problem-solving.

Popular Schools offering Rn Registered Nursing Programs

quickinfoThese schools offer particularly quick info upon request, and we have written detailed profiles for each (click school names to see the profiles).

Request info from multiple schools, by clicking the Request Info links.

Matching School Ads
Platt College
Alhambra

Turn your talents into a career at nationally recognized and accredited Platt College.

  • Programs: Vocational Nursing Program*
  • Degrees: Associate

Pursue your education at Ohio Christian University.

  • Programs: Bachelor of Science in Nursing (BSN)
  • Degrees: Bachelor

Wilkes University’s School of Nursing offers CCNE-accredited online degrees and certificate programs ideal for working health care professionals, instructed by experienced, respected faculty dedicated to mentoring and personalized support for every student.

  • Programs: RN to BS, RN to MS - Nursing Informatics, M.S. with Major in Nursing - Nursing Informatics, more...
  • Degrees: Bachelor, Master, Doctorate

Liberty University provides a world-class education with a solid Christian foundation, equipping men and women with the values, knowledge, and skills essential for success in every aspect of life.

  • Programs: Master of Science in Nursing: Nursing Administration, Master of Science in Nursing: Nurse Educator
  • Degrees: Master

For over 35 years, Keiser University has maintained a practical, hands-on approach to career education to help our students achieve their personal and professional goals. 

  • Programs: Master of Science in Nursing
  • Degrees: Master

Earn your graduate degree online with Northcentral University.

  • Programs: Doctor of Education - Nursing Education
  • Degrees: Doctorate

Saint Xavier University, Chicago’s oldest Catholic university, has a long history of educating students to prepare them for professional success and lay the foundation for personal fulfillment.

  • Programs: MSN in Clinical Leadership, MSN in Executive Leadership
  • Degrees: Master

About Brightwood College

Brightwood College offers accelerated programs that combine flexible schedules and professional instruction to create a rewarding learning experience for individuals focused on gaining the skills for specific careers. Brightwood College is owned and operated by Education Corporation of America.

  • Programs: Vocational Nursing
  • Degrees: Diploma

As a student at South University, Online Programs you will receive the same quality instruction, variety of learning options and level of service found at the campus locations.

  • Programs: Healthcare Management (BS), Nursing (RN to BSN), RN to Master of Science in Nursing with a specialization in Family Nurse Practitioner (RN-MSN), more...
  • Degrees: Bachelor, Master, Certificate

About the University of Rhode Island

 

The University of Rhode Island has grown from an agricultural school and agricultural experiment station to the community-committed university it is today—a place where ideas unleash potential and diversity incubates creativity.

  • Programs: RN to BSN
  • Degrees: Bachelor
Matching School Ads

Additional Career Stories for Registered Nurses

The inside stories from people actually working in the field.
Click a story title to show the story, and click the title again to hide it.

All Types

You are visiting:

Find a school near you

What are Career Stories?

Career Stories are concise, real-world career overviews written by people relating their personal career experiences and wisdom. They provide invaluable insights and mentoring advice to students and career changers.

Most stories include:

  • a typical day or project
  • tips and advice
  • best and worst parts
  • educational background
  • previous experience

Browse hundreds of Career Stories

More Details On This Career

Please also see our detailed information about Registered Nurses, including:

Back to Top