Workers Compensation Utilization Review Nurse Case Manager (00113024) at County of Riverside in Riverside, California

Job Description:

The County of Riverside's Department of Human Resources is seeking a temporary and permanent Workers' Compensation Utilization Review Nurse Case Manager to support the County of Riverside Workers' Compensation Program.

The most competitive candidates will have knowledge of CA MTUS, ACOEM,ODG and RFA's. Recent nursing experience with Utilization Review for a workers' compensation department or self-insured program is highly preferred.

Additional Pertinent Information:

• 9/80: In office during training from 8:00am - 5:30pm


• Opportunity for remote work.

Meet the team!

The Human Resources Department strives to effectively serve and partner with our community, departments and employees by leveraging best practices and innovation to foster a thriving county.• Assesses, plans, implements, coordinates, monitors and evaluates medical services, utilization review and return to work options for injured employees; is a department resource for medical inquiries, claim file reviews, and utilization review.

• Provides medical, behavioral/motivational, occupational, and economic management activities for employees with work related injuries and provides early medical management intervention for new injuries, consulting on medical only and lost time injury files and utilization review on all requests for medical treatment.

• Evaluates health care services of requesting physicians based on the appropriateness of the service and the level of care at which this service would be delivered; is a neutral advocate for employees.

• Performs utilization review in concert with the utilization review physician to approve, delay, modify, or deny treatment.

• Performs medical reviews on Workers' Compensation claims and provides recommendations which are preemptive, focused on moving the injured employee along the healing continuum, return to work opportunities, and employer protection.

• Applies clinical expertise as a resource to the adjuster, employee, and the employer to identify the best results while coordinating the appropriate resource utilization; identifies and manages patient problems to eliminate duplication and fragmentation of health cares service.

• Assists in the development of policies and procedures, standards of care and practice, and in the monitoring of those standards to ensure regulatory compliance, as required by the Division of Workers' Compensation and the Department of Insurance.

• Promotes collaboration among other departments, programs, physicians; represents the Workers Compensation Division when needed in business meetings.OPTION I

Experience: Five years full-time RN experience in a Managed Care or Occupational Health setting to include experience in Workers' Compensation and Utilization Review.

OPTION II

Education: A bachelor's Degree in Nursing, Health Related discipline or Education.

Experience: Three years of experience in Workers' Compensation and Utilization Review.

Possession of a valid California State Public Health Nursing Certificate.

OPTION III

Education: A Master's Degree in Nursing, Health Related discipline or Education.

Experience: Two years of experience in Workers' Compensation and Utilization Review.

Knowledge of: Workers' compensation and utilization review principles and practices; managed care and occupational health issues and standards; application of the nursing process; full range of registered nurse duties and responsibilities; principles and methods of supervision and training; basic management skills; problem solving techniques.

Ability to: Plan, organize, supervise and evaluate nursing services on specific unit(s); communicate effectively; positively manage change and conflict; interpret licensure and accreditation standards; analyze and draft department policies and procedures; apply productive problem solving skills; write clear and concise reports; perform registered nurse or public health nurse responsibilities according to the State of California Nurse Practice Act; implement the nursing process.For further information regarding this posting, please contact Denise Decamp, (ddecamp@rivco.org)