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Denise Z. Gillen, RN, BSN, COHN-S, CM, is hard-pressed to recite every single component of her job description; it’s that big. As manager of medical case management and loss prevention services for HSC Risk Management Services, a TPA based in Albuquerque, NM, she is an example of the career possibilities that exist for occupational health nurses in today’s business environment.
"HSC was originally established to specialize in helping hospitals with administrative issues and the challenges of doing more with less," she observes. "Now we service hospitals, manufacturing companies, hospitality organizations and construction companies." The company currently serves a total of over 2,000 employers, she adds.
On the medical case management side, Gillen oversees a team of nurses that provides occupational case management services to injured workers in New Mexico, Texas, Colorado, and Arizona. "We work with employers and employee groups in setting up occupational health programs, return to work programs, OSHA [Occupational Safety and Health Administration] compliance, and so forth," she says.
"On the workers’ comp side, we also provide telephonic and field case management services. We have an integrated disability management program — workers’ comp with short- and long-term disability; case management services for property, casualty and utilization review; and job analysis for small employers. Also, we do life care planning for catastrophic claims; hospital and construction are the highest risk claim areas."
And that’s just one of her hats.’ "My other hat is loss prevention," she says. This encompasses, among other services, annual safety audits for hospitals, a self-insured group of nursing homes, and self-insured hotels and motels. Her department also teaches life safety courses such as defensive driving, which is required for personnel of any health care provider who transport patients. In addition, she provides training for handling bloodborne pathogens and hazardous materials, back care and proper lifting techniques, fire prevention, electrical safety, lockout/tagout, ergonomics and supervisory accident and incident investigation.
Gillen has been in her current position for two years, and says her career has been a logical progression. "Previous to this position I was working for another TPA as a consultant, doing more of the hands-on case management," she recalls. "Because of my occupational health nursing background, I was able to handle the type of claims that a traditional case manager might not have, such as chemical exposure or occupation diseases," she notes.
She has also worked for a large national manufacturing company as part of its environmental health and safety team. "I worked with the ERT team and first responders," she says, adding that having been on both sides of the health care equation is an invaluable asset. "It’s important to use occupational health nurses on the insurance side because we can bring that balance in," she observes. "We are able to say, I’ve worked on the employer side. I know what those needs are, and now that I’m on the TPA side, I can balance out the needs of the client and of the TPA.’"
Gillen notes that she needed more than a variety of jobs to prepare her for her current position; she has had to constantly expand her knowledge base. "I’ve had HazMat training, OSHA’s 24-hour training course — a lot of courses in that particular area," she notes. This did not happen by accident; Gillen had a plan in mind. "I really felt like case management was the future, and that the occupational health nursing profession was moving towards more of a business approach," she notes. "This was an intuition that has proved absolutely accurate over the last two years."
As part of the business team at HSC, Gillen works closely with the manager for workers’ comp claims. "He manages the adjusters, so we are an integrated team," she explains. "Our model is an integrated disability/case management model where the adjuster and the nurse are put on the claim at the same time."
Gillen sees more positions like hers opening up in the future for occupational health nurses. "The role of the occupational health nurse is changing, especially with the advent of telehealth and telemedicine," she observes. "More and more they will be moving into business positions and managing large programs. It’s an opportunity those of us who have an employer background plus experience on the insurance side to be able help mold a practice area for ourselves."
Does it represent an opportunity to increase income as well as job responsibility? "Absolutely," Gillen concludes.
[For more information, contact: Denise Z. Gillen, RN, BSN, COHN-S, CM, manager, medical case management and loss prevention services, HSC Risk Management Services, P.O. Box 92200 Albuquerque, NM 87199-2200. E-mail: email@example.com. Web: www.nmhsc.com.]