Job Overview:
Nurse consultants participate in the WSIB structured case management framework by:
Interacting, developing and maintaining collaborative working relationships with case managers, return to work specialists, workers, worker families, health care providers and other WSIB staff to recognize and respond to complex needs, make and communicate timely, quality evidenced based/informed health care entitlement decisions.
Apply nursing knowledge, skill and judgement when providing clinical advice, opinion and guidance on the trajectory of a worker’s recovery plans and/or interpret medical/clinical findings as needed to ensure case progression towards achieving the best possible return to work, recovery, and/or quality of life outcomes throughout the case life cycle.
Undertaking interventions to identify and mitigate obstacles to return to work and/ or recovery, resolving what is clearly of a medical/clinical nature and addressing non-medical issues appropriately, to prevent cases from becoming chronic. The individual case characteristics and nature of the obstacles will determine the scope and duration of an intervention.
What you’ll do:
- Identify treatment(s) to support the case plan and intervene when needed with health care providers to resolve concerns and to promote the integration of the worker’s treatment and recovery into the RTW process by:
- Provide immediate, short-term crisis intervention services for workers and/or workers’ families who are at risk of self-harm and/or harm to others.
- Perform other related duties as required or assigned including participation in business, team, or project activities.
- Act as a clinical resource to internal staff by providing advice, opinions, and guidance about health care related questions and the interpretation of medical/clinical findings related to the treatment or recovery of a worker.
- Remain current in their clinical education by participating in various clinical education sessions including clinical forums or other programs as provided/arranged by the WSIB regarding relevant new guidelines, evidence based practice, clinical practice/processes and provide feedback on current trends which impact duration or recovery and RTW, health care benefits.
- Providing appropriate education to prevent further recurrences or new injury in cases where the worker has had multiple similar injuries or recurrences.
- Attempt to resolve objections to health care entitlement decisions made, manage reconsideration requests, and if unable to resolve the objection, arrange for access and process the objection. Implement health care components of appeals decisions within required timeframes.
- Case conference with discipline specific PPLs and or Staff Physicians
- In specific cases, collaborate with the Case Manager Return to Work Specialists, workplace parties and health care providers on case plan activities and timelines by:
- Facilitating access to care and clinic referrals; providing information and support to the health care community;
- Render health care and dental entitlement/compatibility decisions based on legislation, policy, best practices and clinical judgement and communicate them, verbally and in writing.
- Identifying and undertaking interventions and mitigating strategies to overcome recovery obstacles and assist in achieving optimal recovery and quality of life outcomes (note: the individual case characteristics and nature of the obstacles will determine the scope and duration of an intervention).
- Performing an appropriate assessment (e.g. triage, focused, intake, discharge) to assist in identifying appropriate queues, barriers such as clinical, psycho-social and chronic pain issues likely to stall or delay RTW and/or recovery;
- Conducting medication reviews to identify, address, and/or communicate potential issues that may affect RTW, and/or the health and quality of life of a worker;
- Encouraging discussion between providers and WSIB physicians.
- Informing workers and employers of their rights and responsibilities under the relevant health care provisions of the Act;
- Educate and influence workers and external providers/partners regarding RTW best practices, health care guidelines, policies and processes, recommended treatment(s) for the type of injury/illness, and the value of RTW in the healing process to support the RTW and recovery and/or quality of life goals for the case by:
- Assess medical/clinical documentation for completeness, correctness and timeliness and take appropriate action with providers such as reducing payment for late billing. This may include referral to and/or working collaboratively with Health Services and/or Regulatory Services Division for appropriate action.
What you’ll have:
- 3 years prior experience in a clinical environment (i.e. primary health care, occupational health, adult acute/community care)
- University completion at undergraduate level with a specialty focus in Nursing or, prior to 2005, a diploma or bachelor’s degree in Nursing as recognized by the College of Nurses of Ontario. A certificate of registration as a Registered Nurse as a member in good standing with the College of Nurses of Ontario in the General Class.
- Experience counselling workers and families, and ability to initiate appropriate action
- Demonstrated evidence of ongoing education and professional development
- Experience or certification in Disability Case Management an asset