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.
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.