Clinical Resource Review Nurse
CareWorks (a York Risk Services company)
Clinical Resource Review 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:
Provide medical guidance and support to a team of Case Specialists in accordance with Company and BWC policies and procedures
Evaluate, authorize and deny treatment authorization requests in accordance with Company and BWC policies and procedures
Facilitate RTW and medical issues between employers, providers, Third Party Administrators and Case Specialists as needed
Audit treatment authorization requests for Case Specialists to ensure accuracy and timeliness in accordance with Company and BWC policies and procedures
Staff treatment authorization requests with Physician Advisor staff per company policy
Backup other CRR's and Case Managers when caseloads exceed established URAC standard
Assist with Case Specialist caseload reviews as needed for claims management direction
Provide ongoing training to Case Specialists and to new CRR's
Estimated Salary: $20 to $28 per hour based on qualifications.
Clinical Resource Review 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:
Provide medical guidance and support to a team of Case Specialists in accordance with Company and BWC policies and procedures
Evaluate, authorize and deny treatment authorization requests in accordance with Company and BWC policies and procedures
Facilitate RTW and medical issues between employers, providers, Third Party Administrators and Case Specialists as needed
Audit treatment authorization requests for Case Specialists to ensure accuracy and timeliness in accordance with Company and BWC policies and procedures
Staff treatment authorization requests with Physician Advisor staff per company policy
Backup other CRR's and Case Managers when caseloads exceed established URAC standard
Assist with Case Specialist caseload reviews as needed for claims management direction
Provide ongoing training to Case Specialists and to new CRR's
Estimated Salary: $20 to $28 per hour based on qualifications.
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