Nurse Medical Review II

Dublin, Ohio
Not Specified
Jul 11, 2018
Sep 09, 2018
Job Type
Not Specified
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 Two Years in a Row" 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.

Job Description

  • 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
  • Be fully prepared to transfer to Case Manager role when caseloads exceed established URAC standard
  • Assistance with Case Specialist caseload reviews, as needed, for claims management direction
  • Ongoing training to Case Specialists
  • Assist with Performance Evaluations from a treatment standpoint
  • Backup to other CRRs
  • Availability to train new CRRs

Required Skills:

  • Ability to demonstrate knowledge of current treatment practices and protocols
  • Familiarity with workers compensation rules and policies preferred
  • Excellent interpersonal, communication, problem solving and computer skills
  • Excellent customer service and team building skills
  • A positive attitude and demonstrated flexibility

    Required Experience:

  • 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

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