- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
- 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.
- Ability to demonstrate knowledge of current treatment practices and protocols
- Familiarity with workers compensation rules and policies
- Excellent interpersonal, communication, problem solving and computer skills
- Excellent customer service and team building skills
- A positive attitude and demonstrated flexibility
- Licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline
- 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
- At least one of the following credentials:
- Certification as a case manager in one of the following: 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);or
- A bachelors (or higher) degree in a health or human service related field; or
- A registered nurse (RN) license