Denise Wrenn, certified occupational health nurse and Occupational Health Consultant at Cleco Corporation, is our March “Women in Comp” featured executive. Read on for Wrenn’s take on why nurses need more managerial opportunities and how young women can break into business with confidence.
Comp Blog: Tell us about your personal background. Did you grow up in Louisiana?
Wrenn: I grew up in New Orleans and I went to school at St. Mary’s Academy which is an all-girls Catholic school in New Orleans. There were three children in my family, I have a brother and a sister and we actually lived out in the Kenner area, so I would have to get up in the wee hours of the morning to travel to school because St. Mary’s is all the way over on Chef Menteur Highway in the East.
Comp Blog: Other than the commute, did you enjoy going to school at St. Mary’s and growing up in the area?
Wrenn: Yes definitely. I was in the band while I was in school and we had the opportunity every year to march in the Mardi Gras parades; it was always one of the highlights of our year to prepare for the parades.
Comp Blog: So what was your instrument?
Wrenn: I played the saxophone! I don’t play anymore, but I think the creative talents shifted down to my children.
Comp Blog: Are your children in creative fields?
Wrenn: Well, I have three children. My son is definitely in the most directly creative field. He’s an exercise physiologist and he owns his own dance and fitness company. He is known for his Latin music and dance with a focus on Cuban rhythms and he travels all over the country doing exhibitions but his home base is in Michigan. My youngest daughter, an attorney who practices in Las Vegas, also played piano throughout her undergraduate program. My middle daughter is a Gynecologic Oncologist in Ohio and was named one of Cincinnati’s top doctors in her field. Her creative route was on the athletic side, during her undergraduate years she was a member of Tulane’s cheer team.
Comp Blog: Do you feel that, similar to the way you fostered creativity and professionalism in your children, that your upbringing laid the groundwork for the level that you’ve reached in your career up to this point?
Wrenn: Yes, I came from a family with a very strong work ethic. Especially because we always lived in Kenner and went to school and work in New Orleans, there was a sense of organization and routine growing up. My parents also definitely encouraged college and wanted to pass that on to us because they did not go to college and wanted us to have that opportunity and the success that can come with that.
And even though both my parents just finished through high school, they both had an entrepreneurial spirit. In fact, my Dad had a second job as a cab driver and his philosophy with that was “own your own,” and so he did and he ran it like a small business. My Mom too, even though she mostly stayed at home with us, had a creative entrepreneurial side. She had what we used to call a little “sweet shop” out of the house, so she sold sweets to the kids in the neighborhood, this was her spending money and she used it to change things up and give the house a fresh look.
So all in all, my parents really pushed work and education but that was balanced by this understanding of having “your own” and providing for yourself.
Comp Blog: How did you get your start in the workers’ comp industry?
Wrenn: My training is as a registered nurse. It’s somewhat unusual in this role here at Cleco but I think it’s the perfect combination from a workers’ comp standpoint.
I started out in critical care nursing and pursued that; it’s really what I wanted to do from the beginning of my nursing career. I went to school at the University of Texas and they had a series of specialty courses for people coming out of a BSN program that wanted to do critical care. They did not believe that a nurse coming out of any program could do critical care, so they had an additional twelve week course which I was accepted into and completed, plus another six weeks of hands-on training with experienced nurses in the critical care unit. So I started my professional career at University Medical Center in San Antonio, Texas. I also hold a Master’s degree in Health Care Administration from Central Michigan.
Comp Blog: What led you back to Louisiana with Cleco?
Wrenn: My husband at the time was a physician in the military so we eventually moved back to Louisiana from Texas. I worked at Christus St. Frances Cabrini in the critical care unit and I also taught allied health courses at Louisiana Technical College in Alexandria, which I really enjoyed. That program eventually ended and one day I got a call from a friend saying that Cleco had a position open and that they were looking for a nurse. I was really excited about it because it went hand in hand with another one of my goals: to work in a corporate environment that would allow me to function autonomously as part of a large multiprofessional team, and address the safety and health protection needs of working populations.
I applied for the position and there were a lot of people interested but after my interviews they came back and said “we want you” and I accepted. As it turns out, I am actually the first and only nurse hired in the history of the company.
Comp Blog: So how has your position evolved since you’ve been with Cleco?
Wrenn: I initially worked in the human resources/benefits section of the company because they wanted a nurse to help out with those large claims – those million dollar claims that they needed to get a handle on. So I worked with the benefits department to put programs in place to address claims that would have potential impact for savings. Among those programs were wellness initiatives, healthy baby, smoking cessation programs and the like.
Around 1993, the company went through realignment and we determined that a better fit for my expertise would be in the safety department. My job duties changed accordingly to the administration of safety, health promotion, health protection and health care initiatives for our employees. Anything that had to do with the health and safety of each employee was part of my mission. Then, we had another re-organization and I was able to work strictly in the workers’ comp portion doing the workers’ comp management, health and wellness and medical surveillance. It was perfect since that’s where I wanted to be. This was back in 2000 so about 15 years ago is when my career path led me to the workers’ comp industry.
Comp Blog: What is the most significant problem you see in Louisiana’s workers’ comp system and what experience do you have coping with this problem?
Wrenn: For me it’s definitely pharmacy as medication expenses are very high. Many of the injuries we see relate to degenerative back issues that were aggravated and often become chronic back pain. These claims tend to have medications that are dangerous, like narcotics. The potential for complications is huge. For that reason, I will request our pharmacy benefits management group to review all medications to see if there is overlap or if there are medications that can be eliminated or substituted. If there is any opportunity for change that would benefit the employee, not hinder the course of treatment, and have a cost saving benefit, I discuss these issues with the treating physician. Sometimes they agree and sometimes they don’t, but often times they will make some sort of change that is beneficial for both the employee and the company.
Comp Blog: How do you think we could address that problem in our state system?
Wrenn: I think a formulary would be helpful but even with that, we have two issues. The first is making sure new claims have properly vetted medication regimens and the second is making sure that the workers who are already on these medications are properly weaned and placed on medications can assist them to achieve a therapeutic goal.
Comp Blog: Anything else that could use work?
Wrenn: We have the Medical Treatment Guidelines which have helped. The thing that I like about them is that they give you that five day window to have the treatment looked at and go through utilization review, which is especially important when you’re talking about things like physical therapy where the doctor routinely prescribes three times a week for a defined number of weeks without having performed an evaluation. The MTGs provide the ability to approve just an evaluation first, and based on the evaluation, determine what is needed to treat the condition. The MTGs can definitely be improved upon, probably by focusing more on evidenced-based practices; I’d like to see us move further in that direction.
Comp Blog: Based on your experience, how can we improve our system on the administration side?
Wrenn: Well, based on my experience, it would be great to have more people with nursing backgrounds in managerial roles. When a person gets injured, you have to look at the whole system and ask questions: what else is going on with this person? What do I need to look at? Someone with just an insurance background doesn’t always understand the interplay of factors related to injury and how mitigating some of those factors can help get the system back into place. We need more trained nurses in executive positions and I hope that becomes more prevalent as a career option for nurses.
Comp Blog: Describe a typical day for you at Cleco. What are your primary duties and who works with you?
Wrenn: We are self-insured for workers’ compensation and we work with a TPA for claims payment, so everything is done in-house except for actually paying out the claims. The TPA adjudicates but everything comes in to me and I take it from the start to the finish, whether we’re talking about medical care, if we’re settling the claim, returning an employee back to work, or if we’re dealing with Medicare set-asides. The good thing about that is that I am there from the initial injury and I talk directly with the hospital, the physician, or the physician’s office staff immediately. I’m not working through an intermediary because I am seen as the case manager. I have the nursing background to do that and I specialize in occupational health, so I’m really assessing the employee as a whole, not just as a patient.
Comp Blog: How large a part does workers’ compensation play in the day to day operations at Cleco?
Wrenn: Safety, wellness and workers’ comp is incredibly important to the bottom line of the company. If you have safe employees that are getting the job done and coming back the next day injury free then you’re keeping workers’ comp out of it. Cleco has a very strong safety culture, and combined with our emphasis on health and wellness, we just have fewer injuries overall.
My “attaboy” is knowing that all of these employees throughout the state are going back to their families at night safe and sound. It’s a very important aspect of life at Cleco.
Comp Blog: You were re-elected President of the Louisiana Association of Self-Insured Employers (LASIE) recently. What professional organizations do you participate in?
Wrenn: In addition to LASIE, I participate in the American Association of Occupational Health Nurses and the Case Management Society of America, and I do some work with the legal nurse consultant group because I work so closely with our attorney. I’m also a member of NAMSAP (National Association of Medicare Set-Aside Professionals) because we do settle cases that may have future medical needs requiring a Medicare Set-Aside allocation. All in all though, I’m a certified occupational health nurse specialist so that’s where I dedicate a lot of my time.
Comp Blog: So considering all of this continuing education and your unique experience in the field, what’s your operating philosophy as you’re managing these claims?
Wrenn: Everything comes down to getting that employee back to work. Our employees want to work, they want to come back. All the tools I have I use to get that person healthy and back to work, and on the company side, I have the duty of keeping costs down.
Comp Blog: Workers’ compensation and safety is a male-dominated sector. Have you felt any effects of this as a woman?
Wrenn: I see myself as having a key supportive role to our executives at Cleco. They don’t have to worry about workers’ comp or injury management because Denise is handling it. In general though, I don’t think that I’ve felt the negative effects of being in a male-dominated industry because I am able to manipulate my strengths on the medical side. Many men in this industry do not have a nursing background so that puts me in a unique position with an advantage!
Comp Blog: Could you expand on that a bit?
Wrenn: I bring a unique set of abilities to the table. Do I have a formal insurance background? No, I don’t. Do I have a law degree? No, I don’t. But I bring a valuable perspective to handling my duties and seeing these claims through from start to finish because medicine was and is my first focus. I make up for the qualifications that I don’t have by offering the best of what I do have and expanding my knowledge at every opportunity.
Comp Blog: Given that “can do” attitude, do you have any thoughts for women looking to break into the higher levels of business?
Wrenn: You have to look at both your life experience and work experience and focus on what you have to offer. That will allow you to bypass any kind of intimidation. Count on your own confidence and unique abilities. Having three kids has also been a real help to me, I see a connection between raising a family to be successful and being successful yourself.