Telephonic Utilization Review RN
Location: Springdale, Ohio
Description: Sheakley is currently interviewing Telephonic Utilization Review RN right now, this career will be ordered in Ohio. For complete informations about this career opportunity kindly see the descriptions. Serve as the first point of contact for treatment plans (C-9). Follow up with all necessary parties regarding treatment requests including injured workers, providers, employers, legal representatives, TPA's, MCO Case Managers and BWC staff. Assess the appropriateness and medical necessity of the treatment requests for utilization review on a prospective, concurrent, and retrospective basis.
Principal Duties & Responsibilities:
Act as a liaison between the case manager and the provider/injured worker and all other parties to the claims. Reports to the UM/CM Team Supervisor Utilizes the Director of Medical Management or UM Clinical Team Lead as a resource for all clinical questions and advice Serve as the first point of contact for treatment plans (C-9). Follow up with all necessary parties regarding treatment requests including injured workers, providers, employers, legal representatives, TPA's, MCO Case Managers and BWC staff. Assess the appropriateness and medical necessity of the treatment requests for utilization review on a prospective, concurrent, and retrospective basis. Coordinate and review the C-9 (treatment plan) and follows the C9 instructions and processes. Assess quality and clinical risk issues on a concurrent basis; report any recognized issue to the Team Leader/Supervisor Assess documentation of medical records for completeness and relationship to the treatment plan Ability to obtain and interpret information appropriate to injured workers needs as required for assessment, treatment, and patient care services Initiate communication as necessary with the injured worker, employer, provider, BWC, and TPA regarding the treatment plans as well as coordinate services with other UniComp departments Provide education and guidance to all parties to the claim; this includes providing direction to any member of the five-point contact Adheres to Chapter 3 , MCO policy reference guidelines related to the C9 requirements. Develop and maintain a positive work atmosphere and support overall team; demonstrate ability to work within a team structure Maintain confidentiality Work independently, efficiently, and deal with priorities Practice nursing within the Scope of Practice as designated by the State of Ohio Board of
Nursing
Responds promptly to emails and phone calls. Ability to utilize and interpret ODG and/or other treatment guideline
Qualifications :
Education and Experience
Ohio Licensed Registered Nurse. May also have certification as a case manager {Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Nurse (CRRN), Certified Occupational Health Nurse (COHN). A minimum of two (3) years of full-time direct care in a health and human services profession; preferably in occupational health or rehabilitation Maintains continuing education as required to maintain licensure and certification Excellent leadership, verbal/written communication skills, strong organizational skills, and excellent decision making
Requirements:
- Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.
- Attention to detail, flexibility, and strong ability to multi-task.
- Problem solving ability.
- Ability to sit for prolonged period of time.
- Ability to answer high call volume while maintaining accurate system notes.
- .
If you were eligible to this career, please deliver us your resume, with salary requirements and a resume to Sheakley.
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Apply Telephonic Utilization Review RN Here
This career starts available on: Tue, 30 Jan 2018 00:47:17 GMT
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