NEL Clinical Specialist

Our priority is the health and wellness of employees and the people of Ontario. As such, this position may involve working from home for all or part of the duration of this position. The WSIB model mixes working from home, office and field. When it is safe to do so, this position may be asked to work in an office.

About the Workplace Safety and Insurance Board (WSIB)

We’re here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. Funded by businesses, we also provide no-fault collective liability insurance and access to industry-specific health and safety information. We are one of the largest insurance organizations in North America covering over five million people in more than 300,000 workplaces across Ontario. For more information, visit wsib.ca.

At the WSIB, you’ll have the opportunity to:

• explore many career paths and follow your passion
• continuously learn and grow professionally
• be recognized for the great work you do
• participate in programs that support your health and wellbeing

You’ll also receive a competitive salary, along with a comprehensive benefit package and defined benefit pension plan. 

Position Title: NEL Clinical Specialist - Temporary

From:  $88,032.00

3 temporary opportunities for up to 18 months

Job Summary

To render and administer Non-Economic Loss (NEL) and Permanent Disability (PD) decisions related to permanent impairment (PI) and permanent disability in accordance with the Workplace Safety and Insurance Act as well as WSIB operational policies.

Major Duties & Responsibilities

1. Conduct clinical reviews for all NEL and PD pension decisions including determinations/assessments, redeterminations/reassessments, composite ratings and reconsiderations on appeals by:

• triaging new referrals to determine if sufficient information is available to make a NEL/PD quantum decision or if additional information is required this includes confirming/verifying maximum medical recovery (MMR), maximum psychological recovery (MPR), and/or permanent worsening date (PWD) and provide a clinical opinion if discrepancies are found
• ensuring the PI/PD diagnosis is compatible with the mechanism of the work injury/disease process, and where there is a discrepancy provide clarification/advice to the referring party on the interpretation of the diagnosis
• rendering decisions to offset PI quantum in accordance with Policy with respect to pre-existing/co-existing conditions by determining that it contributes to the degree of permanent impairment to the same area of the body, based on the medical significance and clinical evidence in accordance with the prescribed rating schedule
• determining the PI/PD percentage quantum based on extracting and analyzing information relevant to PI/PD  to ensure the decision is in compliance with the AMA Guides/PD Rating Schedule, legislation, policies, and PI Program practice and processes
• If a type of impairment is not listed in the prescribed rating schedule, completing an analogous rating using criteria in the prescribed rating schedule for the areal of injury most similar to worker’s impairment
• determining PD percentage quantum and arrears based on medical on file in compliance with Ontario Rating Schedule (ORS), legislation, and operational policies. In the absence of policy or where there is a substantial gap in policy, render decisions based on expert clinical judgement and evidence-based research of the time
• performing complex calculation functions, including determining correctness MMR/PWD and setting arrears in PD cases, and authorizing payment
• implementing and interpret WSIAT and Appeals decisions pertaining to NEL/PD benefits and pre-existing/coexisting impairments, within the required timeframes.

2. Communicate information regarding NEL and PD decisions to all parties by:

• providing written and verbal explanations for all decisions (including appeals)
• informing and educating all parties regarding PI/PD diagnoses, NEL/PD decisions, processes, policies, legislation, practices, and guidelines
• participating in case conferences and collaborating to ensure consistency in the understanding and interpretation of PI/PD diagnoses, application of the AMA Guides, PD Rating Schedule, policies, legislation, practices and guidelines
• attempting to resolve objections to NEL/PD decisions and if unable to change decision, proceed to process the objection

3. Provide expert clinical opinions and technical advice and facilitate education sessions to internal and external parties including but not limited to WSIB Operations staff, Appeals Services Division, workplace parties, FPC, worker and employer representatives with respect to legislation, policies, guidelines and practices related to NEL and PD benefit decisions.  When there is a discrepancy, provide expert clinical and/or technical guidance, advice and education to the enquiring party, which may include but is not limited to interpretation of medical reports/diagnostics, clinical findings, applicable legislation, AMA Guides, policies and adjudicative practice documents pertinent to the PI referral.
4. Maintain knowledge and up to date information on all matters related to PI/PD processes and practice by:

• participating in research activities to ensure practice standards and decision-making are consistent with evidence-based literature
• providing recommendations to management regarding the need for revision of practices, procedures and guidelines, the handling of new or complex issues and the implementation of policy and practice changes
• developing, implementing, and evaluating the NEL Clinical Specialist education program as needed and providing peer mentoring as required

5. Participate in quality assurance related activities within the PI Program by:

• attending regularly scheduled clinical practice meetings
• participating in committee work to improve the consistency of approach regarding PI Program decisions and processes
• participating in comprehensive inter-rater quality review audits that serve to identify best practice improvement opportunities and/or process gaps, and provide feedback and recommendations to management for process change and/or improvement in rendering NEL decisions and consistency of approach in PI program decisions and processes.

6. Provide immediate assistance to a worker in crisis if need arises as per workers in crisis document

7. Perform other related duties as required or assigned.

Job Requirements

Education:

• University completion at undergraduate level with a specialty focus in Nursing, Physiotherapy or Occupational Therapy as per below:

• 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.
• University completion of a bachelor's degree as recognized by the College of Occupational Therapists of Ontario for graduates prior to 2010 or completion of a Master's degree as recognized by the College of Occupational Therapists of Ontario for graduates after 2010. A member in good standing with the College of Occupational Therapists of Ontario and Canadian Association of Occupational Therapists or Ontario Society of Occupational Therapists required.
• Master's degree as recognized by the College of Physiotherapists of Ontario. A member in good standing with the College of Physiotherapist of Ontario.

Experience:

• Three years prior experience in clinical environment as a Registered Nurse, Physiotherapist or Occupational Therapist.

Our commitment to equity, diversity and inclusion

We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.

The WSIB is committed to being accessible and inclusive, and following barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require accommodation through any stage of the recruitment process, please let us know when we contact you and we will work with you to meet your needs.

Disclosing conflicts of interest

As public servants, employees at the WSIB have a responsibility to act in an ethical way at all times to create a respectful workplace and maintain public trust. Job applicants are required to disclose any circumstance that could result in a real, potential or perceived conflict of interest. A conflict of interest is any situation where your private interests may impair or be perceived to impair the decisions you make in your official capacity. This may include: political activity, directorship, other outside employment and certain personal relationships (e.g. with current WSIB employees, customers and/or stakeholders). If you have any questions about conflict of interest obligations and/or how to make a disclosure, please contact the Talent Acquisition Centre at talentacquisitioncentre@wsib.on.ca.

Privacy information

We collect personal information from your resume, application, cover letter and references under the authority of the Workplace Safety and Insurance Act, 1997. The Talent Acquisition Centre and WSIB hiring parties will used this information to assess/validate your qualifications, determine if you meet the requirements of vacant positions and/or gather information relevant for recruitment purposes. If you have questions or concerns regarding the collection and use of your personal information, please contact the WSIB’s Privacy Office at privacy_office@wsib.on.ca. The Privacy Office cannot provide information about the status of your application.

As a precondition of employment, the WSIB requires that prospective candidates undergo a criminal records name check any time before or after they are hired.

To apply for this position, please submit your application by the closing date on the WSIB career portal: https://www.wsib.ca/en/careers