Registered Nurse - Workers' Comp Utilization Review Case Manager (Hybrid - Remote/In-Office)

County of Riverside; Riverside (CA); Hybrid; USD 65,000 - 95,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse for a pivotal role in the Workers' Compensation Utilization Review team. This position offers a unique blend of remote and in-office work, allowing for flexibility while making a significant impact on employee health management. The ideal candidate will have extensive experience in utilization review and workers' compensation, coupled with a strong educational background in nursing. Join a team committed to fostering a thriving community by leveraging best practices and innovative solutions to support injured employees effectively. This role is perfect for those passionate about healthcare and looking to make a difference.

Qualifications

• 5+ years of RN experience in Managed Care or Occupational Health, including Workers' Compensation.
• Bachelor's or Master's Degree in Nursing or related field required.

Responsibilities

• Assessing, planning, and implementing medical services for injured employees.
• Conducting utilization reviews and providing recommendations for treatment.

Skills

Utilization Review

Workers' Compensation

Managed Care

Occupational Health

Problem-Solving

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

California State Public Health Nursing Certificate

Case Manager Certificate

Job description

The County of Riverside's Department of Human Resources is seeking a permanent Registered Nurse (RN) for the Workers' Compensation Utilization Review Nurse Case Manager position to support the County's Human Resources Workers' Compensation Division.

The most competitive candidates will have knowledge of CA MTUS, ACOEM, ODG, and RFA's. Recent Registered Nurse experience with Utilization Review for a Workers' Compensation Department or self-insured program is highly preferred.

Additional Pertinent Information:

• 9/80 work schedule.
• This position offers the opportunity for remote work with a hybrid schedule requiring 2 days in the office each week.
• In-office during training from 8:00 am - 5:30 pm.

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. Responsibilities include assessing, planning, implementing, coordinating, monitoring, and evaluating medical services, utilization review, and return-to-work options for injured employees. The division acts as a resource for medical inquiries, claim file reviews, and utilization review.

Additional duties include providing medical, behavioral/motivational, occupational, and economic management activities for employees with work-related injuries, offering early medical management intervention for new injuries, consulting on medical-only and lost-time injury files, and performing utilization reviews on all requests for medical treatment.

The role involves evaluating healthcare services requested by physicians based on appropriateness and level of care, acting as a neutral advocate for employees, and performing utilization reviews in concert with the review physician to approve, delay, modify, or deny treatment.

Further responsibilities include conducting medical reviews on Workers' Compensation claims, providing recommendations focused on recovery, return to work, and employer protection, and applying clinical expertise to coordinate resource utilization effectively. The nurse will also assist in developing policies, standards of care, and ensuring regulatory compliance.

Collaboration among departments, physicians, and representing the Workers' Compensation Division in meetings are also part of the role.

Option I

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

Option II

Education: Bachelor's Degree in Nursing, Health-Related discipline, or Education.

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

Possession of a valid California State Public Health Nursing Certificate is required.

Option III

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

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

All candidates must possess and maintain a current valid license to practice as a Registered Nurse in California, along with a current Case Manager Certificate. A valid California driver's license may also be required.

Knowledge required includes principles and practices of Workers' Compensation and utilization review, managed care, occupational health issues, nursing process application, supervision and training principles, basic management skills, and problem-solving techniques.

Ability to plan, organize, supervise, and evaluate nursing services; communicate effectively; manage change and conflict positively; interpret standards; analyze and draft policies; apply problem-solving skills; write clear reports; and perform nursing responsibilities according to the California Nurse Practice Act.

For further information regarding this posting, please contact Denise Decamp at [e-mail].