Utilization Management Nurse
CareWorks (a York Risk Services company)
Utilization Management Nurse
www.careworks.com
Skills/
Qualifications:
Current unrestricted licensure as a registered nurse (RN) with the State of Ohio which allows conducting an assessment independently as permitted within the scope of practice
Two years full-time equivalent experience in a clinical setting with direct clinical care preferably in the areas of emergent care, orthopedics, neurology, occupational or sports medicine, home health or community/public health
One of the following certifications as a case manager is preferred: Certified Rehabilitation Counselor (CRC), or Certified Disability Management Specialist (CDMS), or Certified Rehabilitation Registered Nurse (CRRN), or Certified Occupational Health Nurse (COHN); Certified Case Manager (CCM)
Ability to demonstrate knowledge of current treatment practices and protocols
Familiarity with workers' compensation laws, rules and policies
Excellent interpersonal, communication, problem solving and computer skills
Excellent customer service and team building skills
A positive attitude and demonstrated flexibility
Duties:
Evaluate and authorize treatment authorization requests for medical necessity, appropriateness, claim status, and relatedness in accordance with BWC and Company policies and procedures
Identify treatment authorization requests that could prompt Remain-at-Work Services, vocational rehabilitation services and/or active case management and refer to the appropriate case manager or vocational rehabilitation specialist in accordance with URAC and Company policy and procedures
Work with medical providers to identify treatment options to ensure a remain-at-work status
Adhere to established Company and BWC policy and procedures; identify areas for improvement and make recommendations to supervisor
Adhere to established Company policies and URAC confidentiality guidelines
Contribute to overall team and departmental efforts by achieving established performance standards and serve as backup to team members
Estimated Salary: $20 to $28 per hour based on qualifications.
Utilization Management Nurse
www.careworks.com
Skills/
Qualifications:
Current unrestricted licensure as a registered nurse (RN) with the State of Ohio which allows conducting an assessment independently as permitted within the scope of practice
Two years full-time equivalent experience in a clinical setting with direct clinical care preferably in the areas of emergent care, orthopedics, neurology, occupational or sports medicine, home health or community/public health
One of the following certifications as a case manager is preferred: Certified Rehabilitation Counselor (CRC), or Certified Disability Management Specialist (CDMS), or Certified Rehabilitation Registered Nurse (CRRN), or Certified Occupational Health Nurse (COHN); Certified Case Manager (CCM)
Ability to demonstrate knowledge of current treatment practices and protocols
Familiarity with workers' compensation laws, rules and policies
Excellent interpersonal, communication, problem solving and computer skills
Excellent customer service and team building skills
A positive attitude and demonstrated flexibility
Duties:
Evaluate and authorize treatment authorization requests for medical necessity, appropriateness, claim status, and relatedness in accordance with BWC and Company policies and procedures
Identify treatment authorization requests that could prompt Remain-at-Work Services, vocational rehabilitation services and/or active case management and refer to the appropriate case manager or vocational rehabilitation specialist in accordance with URAC and Company policy and procedures
Work with medical providers to identify treatment options to ensure a remain-at-work status
Adhere to established Company and BWC policy and procedures; identify areas for improvement and make recommendations to supervisor
Adhere to established Company policies and URAC confidentiality guidelines
Contribute to overall team and departmental efforts by achieving established performance standards and serve as backup to team members
Estimated Salary: $20 to $28 per hour based on qualifications.
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